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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