Location of Property:                                                                  Date:______________________

___________________________________________________________________________
Description                          Inventory #            Report #            Date Purchased Cost or Value
 
 
 

_________________________________________________________________________________________
Detailed Explanation of Loss: (in case of theft, robbery, or mysterious disappearance, show the name of the Sheriff’s Office notified and the date the loss was discovered.  If such loss was not reported to a Sheriff’s Office at the time of the discovery, give a complete explanation of such failure.)
 
 
 

___________________________________________________________________________
WE HEREBY STATE UNDER OATH THAT THE ABOVE FACTS ARE TRUE AND CORRECT
TO THE BEST OF OUR KNOWLEDGE.

_____________                                 _________________________________
Date                                                               Executive Head of Agency

_____________                                 _________________________________
Date                                                                       Property Officer

_____________                                 _________________________________
Date                                                           Employee Responsible for Property

THIS DATE PERSONALLY APPEARED BEFORE ME, the undersigned authority, in and for ________________________ County, in the State of Mississippi, the above named individuals, who
being first duly sworn, state on their oaths that the above facts are true and correct to the best of their
knowledge.

GIVEN UNDER MY HAND AND OFFICIAL SEAL, this the ________ day of _________, 20___.

                                                                                       _________________________________
                                                                                       Notary Public

NOTE:  This affidavit should be filled out with the Inventory form “D” and Form ______ the same month
             that the property is removed from inventory.