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106 <br /> NC DEPARTMENT OF GOVERNMENT RECORDS SECTION <br /> rt��:!■ <br /> ■i��i NATURAL AND CULTURAL RESOURCES STATE RECORDS CENTER <br /> ■ 'OEM <br /> archives.ncdcr.gov 4615 - • ••• • • • ••11 <br /> Request for Disposal of Unscheduled Records <br /> AGENCY INFORMATION <br /> Requestor name <br /> Location and Agency[e.g., County/Municipality+Department of Social Services] <br /> Phone and e-mail <br /> Mailing Address <br /> In accordance with the provisions of N.C. GEN. STAT. § 121 and § 132, approval is requested for the <br /> destruction of records listed below. These records have no further use or value for official administrative, fiscal, <br /> historical, or legal purposes. <br /> RECORDS TITLE INCLUSIVE QUANTITY RELEVANT PROPOSED <br /> AND DESCRIPTION DATES STATUTORY RETENTION <br /> REGULATIONS PERIOD <br /> Requested by: <br /> Signature Title 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 /> A-20 <br />