STATE OF LOUISIANA
SECRETARY OF STATE
DIVISION OF ARCHIVES, RECORDS MANAGEMENT AND HISTORY
REQUEST FOR AUTHORITY
TO DISPOSE OF RECORDS
SSARC 930 (R 1/12)
TO: RECORDS MANAGEMENT SECTION
DIVISION OF ARCHIVES, RECORDS MANAGEMENT AND HISTORY
POST OFFICE BOX 94125
BATON ROUGE, LA 70804-9125
FROM:
1.
AGENCY NAME
P.O. Box 10408, Ruston, LA 71272
2.
ADDRESS
Nolan Eller
318-257-2935
recordsofficer@latech.edu
3.
NAME OF PERSON WITH WHOM TO CONFER 4. TELEPHONE NUMBER WITH AREA CODE 4A. E-MAIL ADDRESS
5. CERTIFICATE OF AGENCY REPRESENTATIVE:
I hereby certify that I am authorized to act for the head of this agency in matters pertaining to the disposal of records and that the
records described in this List or Schedule are proposed for disposal for the reason indicated:
A.
The records have ceased to have sufficient value to warrant further retention.
B.
The records will cease to have sufficient value to retain them after the date or event indicated.
These records have been converted to Microfilm ; Digital Images.
DATE SIGNED SIGNATURE OF REPRESENTATIVE TITLE
6. Inclusive Dates
7. Description of Records
(List Records Series Title if Records Appear on Agency Retention Schedule)
Your Disposal Authority Request has been:
[ ] Approved Received:
Processed:
[ ] Rejected Returned:
Reason:
[ ] YES [ ] NO Archives
[ ] YES [ ] NO Rec Mgt
Method: [ ] DUMP [ ] SHRED [ ] RECYCLE [ ] BURN [ ]DELETE
[ ] DeGAUSSE/ERASE [ ] CRUSH
University Records Officer
