Form # DPP-HUA-04-04
Approved 04-12-04
Revised 03-17-08
Comm. of Prop. Proc.
PRINT IN TRIPLICATE
Date:
Other:
To Be Returned:
              Government of the U.S. Virgin Islands
                               HOME USE AUTHORIZATION
Authorization No.
*Condition Codes:
Serial No.
Name of User
Justification for Home Use:
Division
Print Name/Title:
User's Signature & Date:
Annual Renewal
Approved by (Sign & Date):
Instructions for Initial Authorization: Complete and send original to the respective Agency Head's Office until the equipment is returned. The Departmental Accountable Officer should also retain
a copy of this form.
* Condition Code:
Location
Department/Agency/Bureau
E - Excellent               G - Good               F - Fair               P - Poor               U - Unusable               L - Lost               S - Stolen               X - Surplus
Instructions for Return: Use retained original, complete bottom portion of form and return to the respective Agency Head's Office. The Departmental Accountable Officer should also retain a copy
of this form.
Complete Upon Return of Equipment
The equipment listed above has been returned.
User's Signature & Date:
Print Name/Title:
Verified by (Sign & Date):
Description of  Equipment
Work Phone No.
Emergency Phone No.
Asset ID No./*Condition Code