ARIZONA STATE LIBRARY, ARCHIVES AND PUBLIC RECORDS
A DIVISION OF THE ARIZONA SECRETARY OF STATE
NOTICE OF DESTRUCTION PRIOR TO RECORDS DISPOSITION DATE
Revised 09/2019 An Equal Opportunity Employer
1901 W. Madison St. • Phoenix, Arizona 85009 • Home Page: http://www.azlibrary.gov/records
Phone: (602) 926-3815 • FAX: (602) 256-2838 • E-Mail: firstname.lastname@example.org
Enter the earliest date records were destroyed under the Records Start Date column and the latest date records were destroyed under the
Records End Date column.
Enter the format of the records destroyed under the Format: Paper, Digital, Microfilm column.
Enter the amount of records destroyed under the Number of Files, Boxes, Reels or Electronic File Size column.
Describe the reason for the destruction of records prior to meeting the minimum retention.
When the extent of records destruction has been determined, please complete the certificate section of the form and mail or e-mail the signed
original to the Arizona State Library, Archives, and Public Records, Records Management Center. At the bottom of the certificate enter the
date on which the records were determined destroyed, and the signature of your agencies Records Officer reporting the early destruction of
Polly Rosenbaum State Archives and History Building
Enter the item number from the authorized schedule you are following.
Use this form ONLY for records that were destroyed prior to meeting the minimum retention requirements set by the approved Retention
In the top section enter the name of your Agency or Public Body, and include any subdivision breakdown for division, department or unit.
List the Record Series titles associated with the destruction based on the title used on the Retention Schedule you are following.
Enter the retention schedule number or date of the authorized schedule you are following.