ARCHIVES AND RECORDS MANAGEMENT
PART 1: REQUEST FOR APPROVAL
Use this form ONLY for records that do not appear on an approved Retention Schedule.
In the top section enter the name of your Agency or Public Body, and include any subdivision breakdown
for division, department or unit.
Fill in the contact information for the requestor seeking approval.
List the record titles requested for disposition based on the terminology used in your office, and briefly
describe what the records are and their purpose.
Enter the earliest date of records you are requesting to be disposed under the Records Start Date column
and the latest date for the records to be disposed under the Records End Date column.
PRE-APPROVAL FOR UNSCHEDULED RECORDS DISPOSITION
WHEN RECORD SERIES ARE NOT ON AN APPROVED RETENTION SCHEDULE
Polly Rosenbaum State Archives and History Building
1901 W. Madison St. • Phoenix, Arizona 85009 • Home Page: http://www.azlibrary.gov/records
Phone: (602) 926-3815 • FAX: (602) 256-2838 • E-Mail: email@example.com
An Equal Opportunity Employer
Enter the format of the records to be disposed under the Format: Paper, Digital, Microfilm column.
Enter the amount of records being disposed under the # of Files, Boxes, Reels; Electronic File Size
Do not complete Part 2 of the form until you have received signed authorization to do so and the
action authorized has been completed.
When the disposition action has occurred, complete the certificate section of the form and mail the
original to the Arizona State Library, Archives, and Public Records, Records Management Center.
Include the name, e-mail and phone number of the Records Officer for your agency or public body who
performed or arranged for the records disposition to occur (for transfering to Library, Archives and Public
Records, or with a contracted vendor for the destruction of the records). Your Records Officer must sign
ARIZONA STATE LIBRARY, ARCHIVES AND PUBLIC RECORDS
A DIVISION OF THE ARIZONA SECRETARY OF STATE