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.. gy 11V1—°:S GOVERNMENT RECORDS SF,CTZDN <br /> �n ' vol ( )1(:11°I 'P 10.1 ANA STATI RECORDS CENTER <br /> IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1111111 <br /> e IIII IIII III I IiIIIIIII � IIII VIII IIII III III Lee ee ee el e 111161111111111111111111 IS' w . 11 11111111 11 111 11111I1 I ylllllllll Igsio 7-731 <br /> Request for Disposal of Original Records Duplicated by Electronic Means <br /> If you have questions, call(919)807-7350 and ask for the Records Management Analyst assigned to your agency. <br /> This form is used to request approval from the Department of Cultural Resources to dispose of non-permanent paper <br /> records which have been scanned,entered into databases,or otherwise duplicated through digital imaging or other <br /> conversion to a digital environment.This form does not apply to records which have been microfilmed or photocopied,or <br /> to records with a permanent retention. <br /> Agency Contact Name: Date(MM-DD YYYY): <br /> Phone (area code): Email: <br /> County/Municipality: Office: <br /> Mailing address: <br /> Record Series Title Description of Inclusive Approx. Volume Retention Period <br /> A group of records as listed in Records Dates of Records As listed in records <br /> records retention schedule Specific records as (1987-1989; (e.g."1 file cabinet," retention schedule <br /> referred to in-office 2005-present) "5 boxes") <br /> Requested by: <br /> Signature Requestor Date <br /> Approved by: <br /> Signature Requestor's Supervisor Date <br /> Concurred by <br /> Signature Assistant Records Administrator Date <br /> State Archives of North Carolina <br /> Physical Addcess State Couciec 51-81-20 <br /> 215 N Blount St Facsimile(919)715-3627 <br /> Raleigh,NC 27601 cecocds @ncdcc.gov <br />