Free 48883 Proof.FH11 - Indiana

STATE ARCHIVES RECORD TRANSMITTAL AND RECEIPT
State Form 48883 (R2 / 6-06) INDIANA COMMISSION ON PUBLIC RECORDS

Reset Form

PAGE NO. OF

TOTAL PAGES

INSTRUCTIONS: 1. 2. 3. 4. 5.

This form is also available at . Complete and send entire form to State Archives prior to transfer. A receipt will be given at the time the records are transferred. NOTES - Please designate importance, if records are scheduled to be sampled. Transmittal must be typed, printed, or reproduced electronically in order to ensure accuracy and legibility. TO FROM
Complete name / division and address of office of origin

AUTHORIZATION TO TRANSFER RECORDS
Signature of records / information coordinator Telephone number Fax number Date signed (month, day, year) E-mail address Telephone number

Name of employee transferring records (if different from above)

STATE ARCHIVES INDIANA COMMISSION ON PUBLIC RECORDS 6440 East 30th Street Indianapolis, Indiana 46219 Telephone: 317-591-5222 Fax: 317-591-5324 E-mail: [email protected]

RECEIPT OF RECORDS
Signature of State Archives employee receiving records Location / address where records may be picked up Printed / typed name of State Archives employee receiving records Accession number Date / Time

RECORD SERIES INVENTORY USE ONE (1) TRANSMITTAL FOR EACH RECORD SERIES NUMBER. NUMBER BOXES IN A CONTINUOUS SEQUENCE, WITHIN EACH SERIES. BOX NO. of of of of of of of of of of of of
DISTRIBUTION: White - State Archives File; Canary - Agency; Pink - State Archives processing

TOTAL

RECORD NAME

AGENCY NUMBER

NUMBER (e.g. 83-79)

DATES

NOTES (See instructions above)