Financial and Accounting Services	F & AS RESOURCE MANAGEMENT TEL NO: (818) 677-2073 FAX NO: (818) 677-3845 MAIL DROP: 8337
	State Trust Account Application
	PLEASE SEND THE COMPLETED FORM TO THE F & AS RESOURCE MANAGEMENT DEPARTMENT, Mail Drop 8337

ANNUAL UPDATE         Chartfield #:

FUND:

DEPT ID:

PROJECT/GRANT:

DATE NEEDED:

ACCOUNT AMENDMENT         Chartfield #:

FUND:

DEPT ID:

PROJECT/GRANT:

DATE NEEDED:

PREPARED BY:

DEPARTMENT:

EXT / FAX:

MAIL DROP:

Enter a brief description of the account's use:

Sources of revenue:

Expenditure categories:

This account is expected to remain active until: or

Should this account no longer be used, indicate State Trust chartfields to TRANSFER into:
This is Mandatory!	FUND:	DEPT ID:	PROJECT/GRANT:	DATE NEEDED:

Responsible Person: (Individual responsible for maintaining account solvency and authorizing expenditures)
Name:	Title:
Signature: _______________________________________________

Department Statement Recipient:

* Individuals (at least 2) authorized to incur expenditures or request disbursements from this account. At least (1) individual MUST have approval in SOLAR Purchasing & Approval of the Procurement Card.

Name:		Name:
Title:		Title:
Signature: ________________________________		Signature:________________________________

Name:		Name:
Title:		Title:
Signature:________________________________		Signature:________________________________

Director/Dean/Financial Mgr Approval: _____________________________________	Date:_____________
Appropriate Area VP Approval: ___________________________________________	Date:_____________
AN ADMINISTRATIVE CHARGE OF 2.75% IS LEVIED ON ALL STATE TRUST REVENUE UNLESS RESTRICTED BY LEGAL OR REGULATORY PROVISIONS.

** Accounting Use Only **
WAIVE:	CAUSE:	DATE:

1. A change in DEPARTMENT STATEMENT must be conveyed to Accounting Services, Mail Drop 8334. (Submit a brief memo indicating the former and revised recipient.

2. At lease one of the individuals listed MUST have approval in SOLAR Purchasing.

University Controller Approval: _________________________________________	Date:_____________