Form # DPP-ASMA-003-2024
Approved 04-12-04
Revised 1-1-2024
Comm. of Prop. Proc.
Date:
Other:
Emergency Phone No.
Asset ID No./*Condition Code
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):
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:
*Condition Codes:
Serial No.
Name of User
Justification for Home Use:
Print Name/Title:
User's Signature & Date:
Annual Renewal
To Be Returned:
Government of the U.S. Virgin Islands
HOME USE AUTHORIZATION
Authorization No.
Division
Location
Department/Agency/Bureau
Description of  Equipment
Work Phone No.
PRINT IN DUPLICATE