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BER RECEIVING ACTIVITY LOCATION NAME, GRADE AND TITLE OF PERSON FROM WHOM RECEIVED ADDRESS (Include Zip Code) OWNER OTHER LOCATION FROM WHERE OBTAINED ITEM NO. REASON OBTAINED TIME/DATE OBTAINED DESCRIPTION OF ARTICLES (Include model, serial number, condition and unusual marks or scratches) QUANTITY CHAIN OF CUSTODY ITEM NO. DATE RELEASED BY RECEIVED BY SIGNATURE SIGNATURE NAME, GRADE OR TITLE NAME, GRADE OR TITLE SIGNATURE SIGNATURE NAME, GRADE OR TITLE NAME, GRADE OR TITL.

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