STATE OF OKLAHOMA

ARCHIVES AND RECORDS COMMISSION

RECORDS MANAGEMENT COORDINATOR APPOINTMENT
	
Name of Agency

	Agency Head

	
Mailing Address

	Telephone Number	
This APPOINTMENT is a  .  .  .

	
     NEW Assignment        or	
     Re-Assignment   (remains the same)	

The person(s) listed below is/are the Records Management Coordinator(s) for this agency:
(If the Coordinator remains the same, but their last name, title, phone number, or address has changed please indicate below.)
	
Name and Title	Division/Telephone Number/Mailing Address
Fax Number/E-Mail Address	

	

	
The following persons are authorized to sign Notice of Intent 
to Destroy Records:

	     Agency Head

	     Records Management Coordinator	
The following persons are authorized to sign Records Transfer Authorization:

	     Agency Head

	      Records Management Coordinator	

_________________________________________________
Signature of Agency Head

_________________________________________________
Date	
	ARC Form 11
Rev.   04/01