Physical custody of 1033 program property accountibility form statement of Physical Custody: By signing for the below 1033 property I am a Law Enforcement Officer of the aforementioned Law Enforcement Agency



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PHYSICAL CUSTODY OF 1033 PROGRAM PROPERTY ACCOUNTIBILITY FORM

Statement of Physical Custody:
By signing for the below 1033 property I am a Law Enforcement Officer of the aforementioned Law Enforcement Agency. I have physical custody of the item(s) listed below and accept personal responsibility for the property. I further understand that failure on my part exercise responsibility for the care and protection of the item(s) listed above could result in pecuniary liability.
Law Enforcement Agency Information:

NAME:

ADDRESS:

PHONE NUMBER:

ITEM NOMENCLATURE:

SERIAL NUMBER

OFFICER NAME (PRINTED)

SIGNATURE OF OFFICER

DATE

QTY OF ITEM










































































































































































































































































































































































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