♻ Printed on recycled paper. Printed by authority of the State of Illinois. February 2015 — 1 — ARD 66.7
If any of the above permanent records are microfilmed, I
hereby certify that they have been reproduced in compli-
ance with standards given in Section 4400.50 of the Reg-
ulations of the State Records Commission.
If the above permanent records are digitized, I certify that
they have been reproduced in compliance with standards
given in Section 4400.70 and will be maintained in com-
pliance with standards given in Section 4400.80 of the
Regulations of the State Records Commission.
(Signature required only if records are scheduled for
permanent retention and have been microfilmed or digitized)
I hereby certify that, in compliance with authorization received from the State
Records Commission, the records listed above will be disposed of on or after
Date
Signature Date
STATE OF ILLINOIS
RECORDS DISPOSAL CERTIFICATE
Send To: Archives
Western Illinois University
1 University Circle
Macomb, Illinois 61455
For Assistance Call: (309)298-
2717
Directions:
1. Fill in all blanks and columns and sign.
2. Send original certificate and a copy to above address 30 days
prior to the disposal date.
3. Retain records and one copy of Disposal Certificate until the
disposal date and approved copy is returned. Retain approved
copy permanently.
APPLICATION #: ______________________________________________________
STATE AGENCY: ______________________________________________________
______________________________________________________
ADDRESS: __________________________________________________________
ADDRESS: __________________________________________________________
TELEPHONE: ________________________________________________________
EMAIL:__________________________________________________
ITEM NO.
FROM
APPLICATION
INCLUSIVE
DATES
VOLUME OF
RECORDS
(Cu. Ft. or MB/GB)
METHOD OF
DISPOSAL
RECORD SERIES TITLE
(Division, Bureau, Section)
(City, Zip Code)
(Street, P.O. Box)
Approved:
________________________________________________________
Chairman, State Records Commission Date
Director, Illinois State Archives
Print name and title on line above
CONTACT
CONTACT
