STATE OF OKLAHOMA

ARCHIVES AND RECORDS COMMISSION

NOTICE OF INTENT TO DESTROY OPTICAL DISKS
	
Name of Agency

	Date Prepared
	Date Received (leave blank)	
Name of Division

	Phone Number
	
Schedule or
RDA Number	Series Number	
Series Title	Inclusive Dates
of Records	Disk
Number	

	

	

	

	

	
	
I hereby certify that for the above listed records, all state and federal audits have been completed, all applicable audit reports have been accepted and resolved by all applicable federal and state agencies and no legal actions are pending.		

_______________________________________________
Signature of Agency Official

______________________________________________
Title of Agency Official

____________________  APPROVED

____________________  DENIED

______________________________________________
Signature of State Records Administrator or Designee

______________________________________________
Date
	
WHITE     - Archives and Records Commission Copy
GREEN    - Records Management Division Copy
YELLOW  - Agency Copy	ARC Form 13
Rev.    07/99	

SUBMIT ALL THREE COPIES TO THE STATE RECORDS ADMINISTRATOR