Appendix B - Forms and Completion Instructions
CO-853 REPORT OF LOSS OR DAMAGE TO REAL AND PERSONAL PROPERTY
This form is to report all losses or damage to real and personal property,
other than motor vehicles, pertaining to theft, vandalism, criminal or malicious
damage, lost or misplaced funds. This form is also used to report expired,
spoiled, obsolete inventory and items recovered.
- Date of Discovery
Enter the date the loss or damage occurred.
- Date Comptroller Notified
Enter the date the Comptroller's Office was notified.
- Agency (Name and Address)
Enter the agency's name and address.
- Location of Property Pertaining to Adjustment
Enter the location of the property being reported.
- Brief Description of Property
Describe the property.
- Reason for Adjustment
Enter the reason for the adjustment.
- Replacement Value
Enter the following on the CO-853:
1) Date purchased or Received and Tag Number.
2) Value Reported on the annual inventory report to the Comptroller's
Office (CO-59). Use the latest one filed.
3) Depreciated Value
4) Cost If Not Reported on the CO-59
- Security - Adequate, Inadequate - Check the appropriate block
depending on the level of security that was in place prior to the adjustment
- What Steps Have Been Taken Within Your Agency To Prevent A
Recurrence? Explain - Give a brief statement of the action taken to
prevent a recurrence.
- Miscellaneous - If the adjustment was not reported immediately,
indicate reason for delay. Complete this section only if the adjustment was
not reported immediately or if there is additional information that should
- Name of Individual to be Contacted Relative to Adjustment
Please provide the name of the individual that can respond if there are any
the Comptroller's Office or the Insurance Company of Record. It may not be
the individual that prepared this report.
- Telephone Number
Please provide a telephone number where the above named individual can
Enter the date that this report is submitted.
Send electronic copies to:
Office of the State Comptroller:
Auditors of Public Accounts:
Administrative Services, State Insurance and Risk Management:
Retain one electronic copy at the agency
- Update the property control records as required.
Follow this hyperlink
for the form.
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