Termination of Employment - NOTIFICATION OF TERMINATION OF

							      NOTIFICATION OF TERMINATION OF EMPLOYMENT: ____________
                                                  (Date)

When an employee terminates for any reason the following information
must be sent to Central Office/Fudgie Parker immediately:



Name of Employee: ____________________________________________



Position: ____________________________________________________



Date of Separation: __________________________________________



Reason for Separation (Voluntary or Dismissal): ______________

______________________________________________________________

______________________________________________________________
(Attach a letter of resignation, if applicable)