REFERENCE REQUEST
STATE RECORDS MANAGEMENT CENTER
RECORDS REQUEST
Use a separate form for each request
| | |
|Request Date | |
| |
|RECORDS REQUESTED |
| | |
|Case Name or Title | |
| | | | |
|Case Number | |Date or | |
| | |Year | |
| | |
|Other Information | |
| | |
| |
|LOCATION OF RECORDS |
| | | | |
|Accession or Lot No. |Box Number |Range(s) |Section(s) |
| | | | |
| | | | |
| |
|REQUESTOR |
| | | | |
|Name | |Title | |
| | | | |
|Agency | |Division | |
| | |
|Street Address | |
| | | | | | |
|City | |State | |Zip Code | |
| | |
|Telephone Number | |
| | |
|e-Mail Address | |
| |
|FOR RECORDS CENTER USE ONLY |
| | | | |
| |Records Destroyed | |Additional Information Needed |
| | | |
| |Records Missing From Box | |
| | | |
| |Records Charged Out to: | |
| | |
|Name Date | |
| | |
|Searcher’s Initials |Date |
Mailing Address: Telephone Number: 410-799-1930
State Records Management Center FAX Number: 410-799-8532
P.O. Box 275
Jessup, Maryland 20794
DGS 550-8 (Rev. 3/06)
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