Sample Memorandum to Employee for Statement of Facts

310 FW 5
Originating Office
Division of Acquisition and Property Policy Management


To: [Employee name. Organizational Address]

From: Chairperson, Board of Survey

Subject: Request for Statement of Facts for [stolen, lost, damaged, or destroyed] Personal Property [insert inventory number, serial number or VIN, and description of property] (Response Due: __________)

Department of the Interior (DOI) and U.S. Fish and Wildlife Service (Service) policy require a Board of Survey (Board) investigate and provide recommendations regarding financial liability for stolen, lost, damaged or destroyed property, when the accountable action determination is gross negligence. 

In accordance with DOI Acquisition, Assistance, and Asset Policy (AAAP-0111), Stolen, Lost, Damaged, or Destroyed Personal Property, you must provide a written statement of facts to the Board within 14 business days of receipt of this memorandum. In addition, you may orally address the Board within the 14 business days. If, because of unusual circumstances, you need more time, immediately send a written request for an extension to the Board of Survey chairperson for consideration.

Your statement of facts should refer to and include a copy of police reports or other written material previously prepared in relation to the theft, loss, damage, or destruction of the property in question. You should also explain what you were using the property for, its location during the time it was in your possession, and location when it was [stolen, lost, damaged, or destroyed].

Your written explanation will become part of the official Report of Survey that the Board prepares. The Board will consider your written and oral statement when making its determination.

If you have any questions concerning this matter, please contact the Joint Administrative Operations (JAO) Branch Chief, Property Operations [name, phone number, email].