EXITING EMPLOYEE CHECKLIST

	Final paycheck, including final vacation pay-out
	Termination Certification
	COBRA information for medical/dental/vision
	Personnel Handbook/manual
	Company owned software
	401(k) Distribution Form
	401(k) Disbursement Letter (if account less than $5,000)
	401(k) Special Tax Information Sheet regarding withdrawals and rollovers
	Joint & Survivor Annuity Form
	Vested Stock Paperwork
	Expense Reports (must be submitted within 30 days of Termination date)
	Company Credit Card
	Laptop computer and any accessories
	Home Office Equipment
	Cell Phone, if owned by Company
	Pager, if owned by Company
	ID Badge
	Keys to building, office, desk & file cabinets
	Reimbursement to the company for hire-on bonus or relocation assistance, if applicable
	Other:

My initial next to each above indicate that I have either received these items from or
returned them to the Company.  If I never had these items, I have noted "N/A" in the
space provided.

The following items are at my home:

And will be returned to the Company no later than:___________________.

___________________________________  ____________________________________
                    Employee Name (Print)                                               (Signature)

       __________________
                   (Date)