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/'14, �,'" <br /> S AR(_.: :„( <br /> � GOVERNMENT RECORD SF;C;TIC7N <br /> ()„„uoo <br /> (�' N( ')1 ,".I w a .:I 1 I,... I (1,/ . STATE RECORDS CENTER <br /> II �III � V� <br /> i o II II IIP0I li �II 1 IIIII o LI� b.&10 III iiiiii l III IIIo-oII 000,ILIIIIII lip 0 <br /> REQUEST FOR DISPOSAL OF UNSCHEDULED RECORDS <br /> TO Assistant Records Administrator <br /> Division of Archives and Records <br /> Government Records Section <br /> 4615 Mail Service Center <br /> Raleigh, NC 27699-4615 <br /> FROM Name <br /> County <br /> Agency or department <br /> Mailing address <br /> Phone or email <br /> In accordance with the provisions of G.S. 121 and 132, approval is requested for the destruction of records listed below. <br /> These records have no further use or value for official or administrative purposes. <br /> RECORDS TITLE DESCRIPTION INCLUSIVE QUANTITY MICROFILMED? RETENTION <br /> DATES (YES OR No) PERIOD <br /> Requested by: <br /> Signature Title Date <br /> Approved by: <br /> Signature (Requestor's supervisor) Date <br /> Concurred by: <br /> (except as indicated) Signature Assistant Records Administrator Date <br /> State Archives of North Carolina <br /> Physical Address: State Couciec 51-81-20 <br /> 215 N Blount Street Facsimile(919)715-3627 <br /> Raleigh,N.C. 27601 cecocds @ncdcc.gov <br />