Transfer of Records
Archives
and Special Collections Institution
Requesting Transfer: ___________________________________________ Department/Office:________________________________________________ Statement
of Representation/Person Authorizing Transfer: _____________ __________________________________________________________________ Address:
_________________________________________________________ Phone:
___________________________________________________________ Signature:
___________________________________Date: ________________ Description
of Records: Span
Dates of Records:
__________________________________________________ Estimated
Volume: ______________________________________________________ Notes
Concerning Disposition: Restrictions
on Access and Use (each with event or date of release): ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Archives
Staff acknowledging Receipt of Records:
__________________________ Position
Title _____________________________________________________ Date_____________________________________________________________ Accession
# ____________________________________________________________
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