Request for the Destruction of Eligible Records Not Stored ...
Florida State Records Center
Request for the Destruction of Eligible Records
Not Stored in the State Records Center
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|Instructions for customer: |
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|Label each box to be destroyed with a completed “Non-SRC Destruction” box label. |
|Remove or deface other Records Center labels on the box, if any. |
|Complete this form. The Records Custodian or designee must sign the form in box 8 certifying the records are eligible for destruction. |
|Fax or mail this form to the State Records Center. |
|1. Name & Address of Requesting Agency |2. Agency Contact |
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| |3. Telephone No. |
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|4. Location of Records |5. Number of Boxes to be Destroyed |
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|6. Work Order Number (SRC use only) |7. Date |
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|8. I hereby consign the number of boxes listed in Box 5, above, to the Division of Library and Information Services for destruction and certify that all|
|public records contained therein are eligible for disposition according to records retention schedules approved by the Division of Library and |
|Information Services. I understand that it is the responsibility of the records custodian to document the disposition of public records according to |
|Chapter 1B-24.003 of the Florida Administrative Code. |
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|___________________________________________________________________________ |
|Signature of Records Custodian Date |
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|___________________________________________________________________________ |
|Printed Name Telephone |
| |9. Disposal Certificate The number of boxes specified in Box 5 above have |
|This form may be faxed or mailed to: |been disposed of. |
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|Florida State Records Center | |
|Department of State | |
|Division of Library & Information Services |____________________________________________ |
|Mail Station 9A |Signature SRC Manager Date |
|Tallahassee, Florida 32399-0250 | |
|Fax: 850.245.6795 | |
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