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Item 1 • Requesting Agency Information: Enter
Name, Address, and Telephone Number of requesting
agency.
Item 2 • Request Date: Enter Date
the form is completed by official initiating the request.
Item 3 • Requested By: Enter Signature
and Title of the official initiating the request.
Item 4 • Requesting Agency Information: Enter
Signature and Title of the official approving the
request.
Item 5 • Record Series Number: Enter
the Record Series Number as it appears on the current
record retention schedule.
Item 6 • Record Series Title: Enter
the Title of the Record Series as it appears on the
current record retention schedule. If there is not a corresponding
record series established on a schedule, contact a Records
Analyst at DARM.
Item 7 • Inclusive Dates: Indicate the
Date Span of the records series slated for disposal.
Item 8 • Record Retention Period: List
the Retention Periods for the record series scheduled for
disposal, as it appears on the current records retention schedule.
If no retention period has been established, contact a Records
Analyst at DARM.
Item 9 • Volume: Estimate and denote
the volume in cubic feet for each record series scheduled
for disposal, and provide a total volume at the bottom
of the column. Note: one full letter or legal size file
drawer contains two cubic feet; fractions should be rounded
up.
Item 10 • Authorization (Audit - County &
Municipal Fiscal Records): Signature block 10A
and Date block 10B are reserved for the requesting agency's
auditor for all County and Municipal fiscal records and must
be signed and dated before submission to DARM.
Item 11 • Authorization (DARM): Blocks
11A thru 11C are reserved form DARM review.
Note:
State Agencies complete Items 1 thru 9; County,
Municipal, and Local Agencies (including authorities and
educational agencies) complete Items 1 thru 10B. The Agency
returns all four (4) parts of the form intact to DARM. Upon
completion of review by DARM personnel, the Followup and
Requesting Agency copies will be returned to the requestor
with Items 11A thru 11C completed. A signature in block
11C indicates formal approval of the disposition request.
Item 12 • Disposition: Indicate
the manner in which the records have been disposed of by
checking the appropriate box in Item 12. In blocks 12A
& 12B the official verifying the disposal must sign
and date the form after disposal of the records.
Send
completed and signed forms, along with a self-addressed
envelope to:
NJ Division of Archives and Records Management
Disposal Requests
PO Box 307
Trenton, NJ 08625
Note:
After receiving approval, records maybe disposed of. Return
the yellow follow-up copy to DARM, the goldenrod to the
Auditor and retain the pink in the Requesting Agency for
permanent retention.
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