Aspen View Regional Division No.19

EDC-E

AUTHORIZED LOAN RELEASE

School: __________________________________

Date of loan: ________________ Date of expected return: ________________

Description / Serial number / Model number or other identifiers:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Condition on loan: ______________________________________________________

Condition on return: _____________________________________________________

I _______________________ hereby undertake to return this item in the condition

borrowed, or to reimburse for repair or replacement.

________________________

Signature

Authorization of loan: ______________________ ________________________

Principal Date

*************************************************************************************

Acknowledgement of return: _________________ ________________________

Date

Notes: ______________________________________________________________

_______________________________________________________________