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NMI 1111 aim <br /> z APC1 <br /> ��f� N( 1:."� � .� .,� �w GOVERNMENT RECORDS SECTION <br /> STATE RECORDS CENTER <br /> V I a I I I I I I I I I I I I I I I I I I pill i i iiui iiiiiu �I I I I I I giq I I I I I I I I I I I I I I I I I I I I I I I I I I I I I <br /> 0 0 0 oo i i iii i���6 III1011111111 m .00 a rrvain. i14.Reauest for Disposal of Oriainal 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 Specific Dates of Records (e.g. As listed in records <br /> records retention schedule records as referred (1987-1989; "1 file cabinet," "5 retention schedule <br /> to in-office 2005-present) 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 Address State Courier 51-81-20 <br /> 215 N Blount St Facsimile(919)715-3627 <br /> Raleigh,NC 27601 records @ncdcr.gov <br />