State Form 16 - Records Destruction Notification - Indiana Government Center South
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1RECORDS DESTRUCTION NOTIFICATION
Commission on Public Records
State Form 16 (R6 / 6-94)
Indiana Government Center South
INSTRUCTIONS:
1. Please type or print in ink.
402 West Washington Street, Room W472
Indianapolis IN 46204
2. Refer to Records Measurement Table to convert
records to cubic feet when recording quantity destroyed.
3. Forward completed notification to address upper right corner of this form.
Mail To:
4. Signature must be signed by hand.
402 WEST WASHINGTON STREET ROOM 472
5. Use original form only, photocopies are not acceptable.
INDIANAPOLIS, IN 46204
These records have been destroyed in accordance with I.C. 5-15-5.1.
Name of Agency
Name of Division
Destruction Date
Records Series Title
Records Series Number
Date of Records
Date
Destroyed By:
Agency Records/Forms Coordinator's Signature
Housed By:
Accession Number
Method of Destruction
Location
For Records Center Use Only
Cubic Feet Destroyed
Box Numbers
Courtesy Destruction
FOR MICROGRAPHICS ONLY
RECORDS MEASUREMENT TABLE:
Initials
Date
1 Archives box (10" x12" x 15" inside) = cu. ft. of records
1 Linear foot of 8
x 14" documents = 1 cu. ft.
1/2"
1 Letter size file drawer = 1
cu. ft. of records
1/2
1 Linear foot of 8
" x 11" documents 4/5 cu. ft.
1/2
Final Destination of Film
1 Legal size file drawer = 1
cu. ft. of records
1/2
1 Linear foot of tab cards = 1/6 cu. ft.
1 number 11 record transfer box = 2 cu. ft. of records
1 Linear foot of 3" x 5" cards = 1/9 cu. ft.
Agency
Archives
DISTRIBUTION: White - Records Management; Canary - Agency; Pink - Records Center
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