DESCRIPTION OF ATTACHABLE ASSETS

Note: PERS retirement funds may not be used. If home is used, please include approximate amount of equity and address of home.

I,      , hereby provide a description of my Attachable Assets:

	     
	     
	     
	     
				      	                  

Signature of Signer

Date

	CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT

	State of California 

	County of 	     

Date

Here Insert Name and Title of Officer

	On	     	before me,      

	personally appeared      

Name(s) of Signer(s)

	who proved to me on the basis of satisfactory evidence to be the person(s)
		whose name(s) is/are subscribed to the within instrument and 
		acknowledged to me that he/she/they executed the same in his/her/their
		authorized capacity(ies), and that by his/her/their signature(s) on the 
		instrument the person(s), or the entity upon behalf of which the
		person(s) acted, executed the instrument. 

		I certify under PENALTY OF PERJURY under the laws of the State of California	 that
		the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature of Notary Public

NOTE: Please be sure that this page includes ORIGINAL SIGNATURES BY NOTARY AND APPLICANT (a copy will not be accepted). To maintain privacy/confidentiality, faculty should detach the completed/notarized page from the application and submit directly to:

The Office of Faculty Advancement
MH 3310 M
MC-8010