Free 43055.PDF - Indiana

TRANSMITTAL (Analysis)
State Form 43055 (R3 / 11-95)

Return to: Commission on Public Records Forms/Records Management 402 West Washington Street, Room W472 Indianapolis, IN 46204

Title

State Form number

Requisition number

TO (Forms Coordinator)

Agency

Date (month, day, year)

FROM (Forms Analyst / Clerk)

Telephone number

ISSUE The type of form you have submitted has been standardized for use by all state agencies / facilities.

ACTION REQUIRED You are using an unauthorized form. Enclosed is the prescribed form which you should request for printing.

Our research indicates that this form has been deleted from the State Forms Data Base.

Please submit a formal letter, signed by the forms coordinator and head of agency, requesting the reactivation of this deleted state form.

The form you have submitted appears to necessitate a consolidation.

Please contact the Forms Analyst concerning consolidation of this form.

The form you have submitted is used by more than one agency / facility.

Please inform the Forms Analyst if the State Form is to be standardized for use throughout all agencies / all your facilities.

This form is primarily used by:

All revisions to this form must be reviewed and approved by their Forms Coordinator ____________________________________________.

The Forms Distribution Center is ready to restock this form.

Please notify the Forms Analyst / Clerk within five (5) working days if you need to make any revisions to the form. Should we not hear from you, the form will be released for printing / restocking in its current version.

Additional information

DISTRIBUTION: White - Form's file; Canary - Agency