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 Items
1 - 5 Requesting Agency Information – Enter:
name, address, telephone number, records retention schedule
number; signature and title of the official initiating the
request; signature and title of the Custodian of Public
Records approving the request; signature of the Records Manager,
and the request date. Note: The Request
Approved By signature may not be the same as the Requested
By signature in Item 3.
Item
6 Archival Review – The signature of the State
or Local Archivist performing the Archival Review for the
records listed in the disposal request.
Item
7 Premature Records Disposal – Enter for disposal
of hardcopy records whose retentions have not yet
expired but were microfilmed, or imaged, or were deemed
unsalvageable due to a disaster.
Item
8 Comments – A field dedicated for associated
comments.
Item
9 Record Series Number - Enter the record series number
as it appears on the current records retention
schedule.
Item
10 Record Series Title - Enter the record series title
exactly as it appears on the current records
retention
schedule. In cases where a record series does not
appear on a schedule, contact a Records Analyst
at the
Division of Archives and Records Management.
Item
11 Records Retention Period - Enter the retention periods
for the expired record series exactly as
it appears on
the current records retention schedule. If no
retention period has been established, contact
a Records
Analyst
at the Division of Archives and Records Management.
Item
12 Inclusive Dates - Enter the From Month/Year dates through
the To Month/Year dates of the
record series
slated for disposal.
Item
13 Dispose After – Enter the date the records
may be slated for disposal.
Item
14 Volume - Enter the volume in cubic feet for each record
series and provide a
total volume
at
the bottom
of the
form. Note: one full letter or legal size
file drawer contains two cubic feet. Fractions
should
be
rounded up.
Item
15 Audit Authorization – The Auditor Signature
for the Requesting Agency, in block 15A and date block 15B,
for all County and Municipal fiscal records.
This must be signed before submission
to the Division
of
Archives and Records Management. State
Agencies complete items 1 through 14
only for fiscal
records.
Item
16 DARM Authorization (Division) - Blocks 16A through 16C
are reserved
for
the Division
of Archives
and
Records Management.
Item
17 Disposition - Enter the manner in which the records
have been disposed
in Item
17.
In block 17A
include the
signature of the official verifying
the disposal and the verification
date in
block 17B. NOTE:
Return all
four
(4) parts of the form intact, to
the Division. The Follow-up and Requesting
Agency copies
will be returned
to you with items 16A through 16C
completed - a Signature in block
16C indicates
formal approval
of the
disposition request. After disposal,
return the Yellow, DARM Follow-up
copy to the
Division, the Goldenrod,
Auditor copy to the Auditor, and
retain the Pink, Requesting Agency
copy to
complete the process.
Please
include a self-addressed envelope
for expedited service.
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