KEY(S) RETURNED FORM

							                               KEY(S) RETURNED FORM



University of Wisconsin-Whitewater                          Date
                                                                   ───────────────
Name of Faculty/Staff Member
                            ──────────────────────────────────────────────────
Building                                   Department
        ──────────────────────────────────            ─────────────────────────
The above named individual has returned the following key(s) to me. They             (
  have    have not) returned all University keys which were issued to them
 ───    ────
through my office.


Key(s) Returned

BUILDING NAME           ROOM NUMBER/DESCRIPTION                KEY NUMBER

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Verified:                                                Date
         ───────────────────────────────────────────────      ─────────────────
         Key Coordinator




         WHEN FORM IS COMPLETED SEND TO:   FACILITIES PLANNING & MANAGEMENT

..............................................................................

Verified:                                                Date
         ───────────────────────────────────────────────      ─────────────────
         Executive Director of Facilities Planning & Management


cc:   Key Coordinator
      Personnel