Notice Of Intent To Vacate Government Owned Or Leased Quarters
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1NOTICE OF INTENT TO VACATE
Department of Transportation
U.S. Coast Guard
GOVERNMENT OWNED OR LEASED QUARTERS
COPIED FM ISCAHSG-003
USE OF FORM: This form shall be submitted to the Local Housing Office 45 days in advance of your anticipated
departure / vacating date. Please complete all blocks and print legibly.
Name
Emp ID:
Rank
(last, first, MI)
Current Quarters and Phone Number:
Bedroo
Category Type:
m Size:
Government Owned Family Quarters
Leased Family Quarters
Unaccompanied Personnel Leased Housing
(UPLH)
Unaccompanied Personnel Housing (UPH)
Current Duty Station and Phone Number:
New Duty Station:
Reason for Vacating:
PCS Transfer
Discharge/RELAD
Retirement
________________________________________________
Relocation to:
Other:
Inspection Dates: Fill-in
Pre-Check-out and Final inspection dates/times. You are responsible for being at your unit at these
times. Reminder that changes to the below can affect scheduled check-in dates for incoming personnel.
Contact Housing immediately of any changes to the below.
Pre-Check Out Inspection Time and Date:
Final Inspection Time and Date:
Tenant Signature:
Date:
Inspection Dates noted in appt book (Housing Rep Signature):
Date:
Housing Use Only
Unit Cleared by
Date:
(Housing Management Signature):
No. of Keys Returned:
Mailbox Keys Returned:
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