Information about your agency

Agency name (required)

Mailing address (required)

Records officer name

Name of person submitting form (required)

Phone number

E-mail address

Information about the record series
Only records listed as permanent on an approved records retention schedule are eligible for transfer to the State Archives.

Series title (required-see agency records retention schedule)

Series number (required-see agency records retention schedule)

Inclusive dates of records to be transferred (required-month/year: e.g., 9/1995)

Total number of boxes to be transferred (required)

Records include (in addition to paper files)

Specify other types (e.g., audio tapes)

Information about the box contents
For each box you request to transfer, please include a brief summary of the box contents; box number; and file arrangement range (e.g., month/year date spans, file number range, alphabetic range, etc.) of what is in each box. Examples:
1. Board Minutes, Box 1, from 8/1989 to 12/1995
2. Board Minutes, Box 2, from no. 476 to no. 653
3. Board Minutes, Box 3, from A to G

List contents below

Click here to send the form to the State Archives.

Click here to clear all of the text from the form. Tip: Do not use this option if you are sending more than one record series. Instead, simply replace the individual fields of information that are different (e.g., series title, box contents, etc.) and submit another time.