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Sw.. .., w".1:. A R( 1 1 IV 11 , GOVERNMENT (OR S SEC;TTC)N <br /> CA hti,���������� (gip 1� 1 ".1,1 1 ""° : (�w: 1,1 . STATE R�;c;()RD S CENTER <br /> 11 11 11 V _���� �..�.��� l�! ��!! 0 1� ° ��� °� I '�:p4�1� !is 1�������� ���� ������ �� <br /> II II �I III VIII II iiiiT ii <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 Courier 51-81-20 <br /> 215 N Blount Street Facsimile(919)715-3627 <br /> Raleigh,N.C. 27601 records @ncdcr.gov <br />