TEMPLATE - AGENCY USE OWN LETTERHEAD



TEMPLATE - AGENCY USE OWN LETTERHEAD

Satisifaction of Conditions for Approval of

Damaged Records Disposal

Certification

TO: Robert Benco, Chief of Operations, Records Management Branch, Division of

Revenue and Enterprise Services, Department of the Treasury

FROM: Agency Contact - Name/Title

DATE:

SUBJECT: Satisifaction of Conditions for Approval of Records Disposal

On DATE, The State Records Committee conditionally approved The AGENCY NAME Request and Authorization For Records Disposal for damaged records. 

I hereby certify that all of the conditions specified in the SRC approval have been satisified.         

                                                         

_________________________________________________

Signature/Title

________________________

Date

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