Issuance of Equipment

Branch.....
District ...Oakland 121
NAME OF CLIENT Willsmore, Herbert R. COUNSELOR meb
ADDRESS 2725 Haste St. Apt. 301, Berkeley, Calif.
No. 1: ISSUANCE OF EQUIPMENT TO CLIENT
Date June 4, 1973
□ Delivered by vendor
□ Issued from stock

Description of Equipment: Cost:

    Description of Equipment: Cost:
  • 1 ea. Chevrolet Beauville Sportvan
  •     $4382.27

"In consideration of the issurance of the above-described motor vehicle to me, I agree to forward the Registration Card (Pink Slip) to the above district office of the Department of Rehabilitation immediately upon receipt thereof by me. I further agree that should my rehabilitation program be terminated prior to completion, I will, upon the request of the Department of Rehabilitation, return the above vehicle to the Department and endorse the Registration Card for transfer of title of the vehicle to the Department."

□ Posted by bookkeeper

Acknowledgment by Client: I agree to keep the above property in good condition or to be responsible up to its stated value for its loss, destruction, or damage. I acknowledge its receipt by me as a loan only and admit that its title and the right to its possession is and remains in the State Department of Education, Vocational Rehabilitation Service, and, waiving all notice of demand, I agree to return it promptly at my expense to the Vocational Rehabilitation Service upon the request of any of its representatives.

_____
Signature of Client
No. 2: DISPOSITION OF EQUIPMENT
Date _____
□ Returned to stock
□ Retained by client
□ Other (explain: sold to client, approved survey, etc.)
_____
_____
□ Posted by bookkeeper
_____
Signature of Counselor
STATE DEPARTMENT OF REHABILITATION
DR FORM 290
ORIGINAL: To bookkeeper to serve as VRA-3
DUPL.: To case folder
TRIP.: To case folder; ultimately to client
QUAD.: To client as receipt on issuance
[illegible data] 4-67 127,500 QUAD ▵ OSP