AMADOR COUNTY UNIFIED SCHOOL DISTRICT

Page \ of ---1l_ Amador County Unified School District /Amador County Office of Education

Request to Surplus

school site/Department: _____..~_.._.'-\t::f-~~""-------- Date Jj~ajf{

Item 1.0 . #and Inventory ~ticker Description of the Item Reason for Surplus Request Including: Brand, Model, Year Purchased

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Superintendent's recommendation for value and disposal method:--------- - - --

RECEIVED Date: ____ _

Board Approval sent to site: _______________ Date: ---- -

Final Method of Disposal: ________ ________ ____ _

Responsible Employee's Signature:------------- Date: ____ _

8/2015

Page c9-- of~

·-Item l.D. # and Inventory Sticker Description of t he Item Reason for Surplus Request

Including: Brand, Model, Year Purchased

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Administrator's Signature: G~; ' b \,. ~ -0.-Date:

DISTRICT USE

Received by Superintendent's Office _____________ Date: ____ _

Superintendent's recommendation for value and disposal method:------------ -

Board Approval sent to site: ______ ________ __ Oate: -----

Final Method of Disposal: ____________________ _

Responsible Employee's Signature:-- -----------Date:-----

8/2015

Page _3_ of ( ~ Amador County Unified School District I Amador County Office of Education

Request to Surplus

School Site/Department: ---"--=+~"'-'ll-J-.....l........:"':::fz::!::_.:;...-------- Date JP (j f I~ Item 1.0. #and Inventory ~ticker

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DISTRICT USE

Description of the Item Including: Brand, Model, Year Purchased

Reason for Surplus Request

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Received by Superintendent's Office _ _ _ ________ __ Date:-----

Superintendent's recommendation for value and disposal method:-------------

Board Approval sent to site: _______________ Date: ____ _

Final Method of Disposal: ____________________ _

Responsible Employee's Signature:------ ------- Date:-----

8/2015

Page Jl of Jl_

Item 1.0. #and Inventory ~ticker Description of the Item Reason for Surplus Request Including: Brand, Model, Year Purchased

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.. c D' UJoY- r Administrator's Signature:--------Date: ___ _

DISTRICT USE

Received by Superintendent's Office ________ _ _ _ __ Date: ___ _ _

Superintendent's recommendation for value and disposal method:-------------

Board Approval sent to site: _ _ _________ _ _ __ Date: _ ___ _

Final Method of Disposal : _______ ______ _______ _

Responsible Employee's Signature: _____________ Date:---- -

8/2015

Page s__ of ( J_ Amador County Unified School District/ Amador County Office of Education

Request to Surplus L { School Site/Department: Date: J -J (] I rq

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Item :.o. :i and Inventory ~ticker Description of the :tern Reason for Surplus Request

lnc!uding: Brand, W1odel, Year Purchased . .. . .... .

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Supcfr1 <:?n- !nt'!: r:? .::ommP . !ion for value and disposal method:---- ·---------

- --- ·-· ---·- -------- -----------Beard Approval t.e: - ----- - - _______ Date: _ ___ _

'1=inal Met hod of LJi:;posa l : ____ _

Rcspor. . ." 1; ie Employe ,, , Signature: _ ___ _ , ___ Date: ____ _

8/2015

Page L ofJL

Amador County Unified School District/ Amador County Office of Education

School Site/Department:

Requestto Surplus Date: [)_&a LJq I '

Item l.D. # and Inventory Sticker Description of the Item Reason for Surplus Request Including: Brand, Model, Year Purchased

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. DISTRICT USE

Received by Superintendent's Office _____________ Date: ____ _

Superintendent's recommendation for value and disposal method:--- ------- ---

Board Approval sent to site: _____________ __ oate: _ ___ _

Final Method of Disposal: ____________________ _

Responsible Employee's Signature: ________ _ ____ Date:-----

8/2015

Page 1-of _\l,_ Amador County Unified School District/ Amador County Office of Education

Request to Surplus

School Site/Department i; J Of }~11115 - .;r: ft) Name of Person Completing Form: 13 tfj:f lJa.,.ta 0 Y\

oate: ___ d-/J_O / ___,___fq _ ~ '

Item l.D. #and Inventory ~ticker Description of the Item Reason for Surplus Request

Including: Brand, Model, Year Purchased

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. . , . C~1 ~r . Administrators Signature.------ --- Date. ___ _

DISTRICT USE

Received by Superintendent's Office ______________ Date: ____ _

Superintendent's recommendation for value and disposal method:--------------

Board Approval sent to site: ________________ Date: - ----

Final Method of Disposal: _____________________ _

Responsible Employee's Signature:--------------Date:------

8/2015

Page _R_ of _il__ Amador County Unified School District / Amador County Office of Education

Request to Surplus / I School Site/Department: lJ, (,1 ~- '10 ,) S - "J: µ ~ Date: d /JO, / q

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Name of Person Completing Form: __ ~~~!e~·~~-~~~~~~~~~~---------~ Item 1.0. #and Inventory ~ticker

Description of the Item Reason for Surplus Request

Including: Brand, Model, Year Purchased , AMADOR COUNTY

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Administrator's Signature:--------Date: _ _ _ _

DISTRICT USE

Received by Superintendent's Office _____________ Date: ____ _

Superintendent's recommendation for value and disposal method:-------------

Board Approval sent to slte: _______________ Date: ____ _

Final Method of Disposal: ____________________ _

Responsible Employee's Signature:-------------Date:-----

8/2015

Page i_ of Q__ Amador County Unified School District/ Amador County Office of Education

Request to Surplus j I School Site/Department: -l""'=""~~j _ O-'-'--aJ_,_c v-=\ S:..___:L--L--_f/( --'-?) _ _ Date d-DM ilq

) Name of Person Completing Form: _________ _ ______ _ _ ____ _

Item 1.0. # and Inventory ~ticker

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DISTRICT USE

Description of the Item Including: Brand, Model, Year Purchased

Reason for Surplus Request

Received by Superintendent's Office _ _ _ ______ _______ Date:------

Superintendent's recommendation for value and disposal method:---------- - - ---

Board Approval sent to site: _ ___ _________ _____ Date: --- - --

Final Method of Disposal : _ _____ ______ _____________ _

Responsible Employee's Signature:------ ----- ----- Date: - --- - -

8/2015

Page _lLotJL

Item l.D. #and Inventory Sticker Description of the Item

Reason for Surplus Request Including: Brand, Model, Year Purchased

- - - - ··-·

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--- -------------------------------------~~-:'.:'.'.'.~~'.~~'.-~'.~~-~'.~'.~'. ... ----~-~}. ______________ ~~-:~: __________________ ___ DISTRICT USE

Received by Superintendent's Office _____________ Date: ____ _

Superintendent's recommendation for value and disposal method:------------

Board Approval sent to site:. ______________ Date: ____ _

Final Method of Disposal: ___________________ _

Responsible Employee's Signature:--- --- --- ---Date:-----

8/ 2015

Item 1.0. #and Inventory ~ticker

DISTRICT USE

Description of the Item Including: Brand, Model, Year Purchased

Reason for Surplus Request

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Received by Superintendent's Office _______________ Date:------

Superintendent's recommendation for value and disposal method:----- ----------

Board Approval sent to site: _________________ Date: ------

Final Method of Disposal: ______ _ ___________ ______ _

Responsible Employee's Signature: - - -------------Date: - -----

8/2015

Page

Amador County Unified School District I Amador County Office of Education

School Site/Department:

Item l.D. #and Inventory Sticker

DISTRICT USE

AMADOR CO UNTY uso

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Requestto Surplus Date ;} I JO!~ Description of the Item Reason for Surplus Request

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Received by Superintendent's Office ____ _____ _ ______ ____ _ Date:---- - ---

Superintendent's recommendation for value and disposal method:------- --- - - - - - - - -----

Board Approval sent to site: _ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ _______ Date:

Final Method of Disposal:------- - ---- --------- -------------

Responsible Employee's Signature:--- ----------- - ----- Date: - -------

8/ 2015

AMADOR COUNTY PUBLIC SCHOOLS Acknowledgment of Donation of Gift/Contribution to District

Date: 2/26/19 School Site I Department: Educational Services Name of person completing this form: Margaret Shoda Description of Gift I Contribution: 2019 Song Books of Amador & Calaveras Counties for all school sites No goods or services were provided by Amador County Public Schools in return for the contribution. Does the gift/contribution require Maintenance Department services for installation? D Yes ~No

If yes, Maintenance Department completes this section. Required materials for installation: __ Labor costs of installation: __ Total: ** Maintenance Director 's Signature:

Name of Donee/Contributor: _L_e_d_,,.g'---e_r _D_i___,spL_a_t_c_h __________ _ Mailing Address: _P_O_B_o_x_1_2_4_0 ______________ _ Town: Jackson Zip: 95642 Telephone No.: 209-223-8761

Have you acknowledged receipt of gift/contribution with a thank you letter? ~YesD No (If yes, please attach a copy of thank you letter.)

**Note: If maintenance and material costs for installation are unbudgeted or prohibitively high, the Superintendent may recommend Board rejection of the gift/contribution.

Form No. 49 (Rev. 3/2008)

February 27, 2019

Ledger Dispatch PO Box 1240 Jackson, CA 95642

Dear Mr. Mitchell,

Amador County Public Schools 217 Rex Avenue, Jackson, CA 95642

(209) 257-5353 ~FAX 257-5360

When Kat Everett contacted us to distribute the song books to our schools we were more than willing to accept this generous offer. The 2019 Song Books of Amador and Calaveras Counties were picked up and delivered to all of our schools for musicians, poets and any and all interested students this week.

We appreciate the Ledger Dispatch partnering with Amador County Public Schools by reaching out to our students and their families in support of the arts. We look forward to our partnership continuing for years to come!

Kind regards,

Y-~£21~ Donna Custodio Director of Student Services

DC/ms