Property Request Form

Any tribal members of the Kickapoo Tribe of Oklahoma can turn in a

property request form to use any tools that you are in need to assist you.

Fill out the form and submit to the Maintenance Secretary.

Date:__________________

Property Requesting:________________________________________

___________________________________________________________

Pick-up Date:___________________

Return Date:____________________

Actual Return Date:______________

1: I take full responsibility if lost, stolen or damaged.

2: I will return the property in the same condition as departed.

I do hereby understand the above policy as mentioned and will abide by

such terms at all time.

Name:_________________________________________

Address:________________________________________________________

Phone:__________________________

Signature:______________________________________

Date:________________

Approved[ ] Disapproved[ ]

Issuer:_________________________________________

Date:________________