STATE OF OKLAHOMA

ARCHIVES AND RECORDS COMMISSION

RECORD CENTER NOTICE OF INTENT TO DESTROY RECORDS
	
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	Volume
Cubic Feet	

	

	

	

	

______________________________________________
Signature of Head of the Records Management Division 

__________________________________________________
Date of Proposed Destruction

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.		

_______________________________________________
Name of Agency Records Management Coordinator

__________________________________________________
Signature of Agency Records Management Coordinator	
WHITE    - Archives and Records Commission Copy
GREEN   - Records Management Division Copy
YELLOW - Agency Copy	ARC Form 3
Rev.   07/99	
RETURN ALL THREE COPIES TO THE STATE RECORDS MANAGEMENT DIVISION