Fillable ARIZONA STATE ARCHIVES AND PUBLIC RECORDS LIBRARY, Pursuant (Arizona State Library, Arhives and Public Records)

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ARIZONA STATE ARCHIVES AND PUBLIC RECORDS LIBRARY, Pursuant (Arizona State Library, Arhives and Public Records)

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ACTION:
Add as RO Remove as RO Update contact information
Does the Records Officer have authority to set policy or procedure? Yes No
Agency/Public Body title
For Records Management Use only:
RM E-mail Distribution List Date: Initials:
RM Database Date: Initials:
Pursuant to ARS § 41-151-14 the head of each state and local agency shall designate an individual to be the Records
Officer Liaison (RO) to the State Library every other year. The Records Officer must be at a level of management
sufficient to direct the records management program in an efficient and effective manner, and shall act as coordinator
and liaison for the agency with the State Library.
ARIZONA STATE
LIBRARY,
ARCHIVES AND PUBLIC RECORDS
A DIVISION OF THE ARIZONA DEPARTMENT OF STATE
Instructions: Fill out this form to notify the State Library of an addition, deletion, or change of the Records Officer, or
to update the Records Officer contact information. Return the signed form to the address below.
Agency:
Division, Department or Unit Name:
Records Officer's Name:
Title:
Mailing Address:
E-mail Address:
Phone Number:
Fax Number:
I designate the above individual as Records Officer for
Head of Agency or Designee (type or print):
Title (type or print):
Signed (Head of Agency or Designee):
Date:
Revised 11/2019
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: rmd@azlibrary.gov
An Equal Opportunity Employer
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ARIZONA STATE ARCHIVES AND PUBLIC RECORDS LIBRARY, Pursuant (Arizona State Library, Arhives and Public Records)

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Completed 20 July 2020

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