The following form must be completed and signed by all employees and appropriate supervisor before releasing individuals final check:

Returned:

_____ Room key(s) to Physical Plant

_____ Building key(s) to Physical Plant

_____ Mailbox key(s) to Business Office

_____ MSU-Northern equipment, tools, supplies

_____ All software copies

_____ Books purchased or sent to MSUBNorthern

_____ Library books and publications

_____ Other:

Paid:

_____ Travel Advances

_____ Parking fines

_____ Library fines

_____ Housing charges

_____ Class and lab fees or charges

_____ Foundation loans:

_____ Other:

Employee Certification and Release:

I certify that to the best of my knowledge I have returned all property belonging to MSU-Northern and paid any amounts due. If I have overlooked something, I understand MSU-Northern or the State of Montana, will deduct charges from amounts due me 10 days after notifying me of such charges at the following address:

Employee Signature: _____________________________________ Date ______________

Forwarding Address: ________________________________________________________

__________________________________________________________________________

Supervisor Signature: ____________________________________Date _______________

(Form must be completed prior to signing final time report.)