RECORDS DISPOSITION AUTHORIZATION STATE OF CONNECTICUT Connecticut State Library Connecticut Towns, Municipalities, and Boards of Office of the Public Records Administrator Education 231 Capitol Avenue, Hartford, CT 06106 Form RC-075 (Revised 01/2010) INSTRUCTIONS: Use this form to obtain approval for disposition (destruction or transfer) of public records pursuant to CGS §7109. If this form is used for educational records, please ensure that the Superintendent of Schools reviews and signs the form. If necessary, use additional forms. Each form must be signed. Please fill-out the form completely and legibly and submit to the above-listed address at least 20 days prior to the proposed date of disposition. Volume of Records: Letter-size drawer = 1.54 cubic ft. / Legal-size drawer = 2.0 cubic ft. / = 1.0 cubic ft Record carton (standard banker’s box) After receiving approval, the original signed form must be retained in the Office of the Town Clerk. The originator of this form (custodian of the record) may keep a duplicate copy. Records that cannot be destroyed have been so noted. LOCAL GOVERNMENT ENTITY: DATE: CUSTODIAN OF RECORDS: PHONE: ADDRESS (form will be returned to this address): I hereby certify that the records listed below have met the retention requirements established by the Office of the Public Records Administrator in the form of approved records retention schedules. No records listed, in our opinion, pertain to any pending case, claim, or action. CUSTODIAN OF RECORD SIGNATURE DATE: (type or print): (Custodian of Record): GOVERNMENT AUTHORIZATION HEAD OF MUNICIPALITY SIGNATURE DATE: or print): (Head of Municipality): (type SUPERINTENDENT OF SCHOOLS SIGNATURE DATE: or print): (Superintendent of Schools): EDUCATION (type AUTHORIZATION SCHEDULE & INCLUSIVE DATES VOLUME OF PROPOSED RECORDS SERIES TITLE SERIES # OF RECORDS RECORDS DATE OF (e.g., M1-080) (indicate cubic ft.) DISPOSITION FROM THRU 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. APPROVED DATE: (Public Records Administrator): PUBLIC RECORDS APPROVED DATE: (State Archivist): AUTHORIZATION PUBLIC RECORDS NOTES:
RECORDS DISPOSITION AUTHORIZATION Connecticut Towns, Municipalities, and Boards of Education Form RC-075 (Revised 01/2010) STATE OF CONNECTICUT Connecticut State Library Office of the Public Records Administrator 231 Capitol Avenue, Hartford, CT 06106 INSTRUCTIONS: Use this form to obtain approval for disposition (destruction or transfer) of public records pursuant to CGS §7109. If this form is used for educational records, please ensure that the Superintendent of Schools reviews and signs the form. If necessary, use additional forms. Each form must be signed. Please fill-out the form completely and legibly and submit to the above-listed address at least 20 days prior to the proposed date of disposition. Volume of Records: Letter-size drawer = 1.54 cubic ft. / Legal-size drawer = 2.0 cubic ft. / Record carton (standard banker’s box) = 1.0 cubic ft After receiving approval, the original signed form must be retained in the Office of the Town Clerk. The originator of this form (custodian of the record) may keep a duplicate copy. Records that cannot be destroyed have been so noted. LOCAL GOVERNMENT ENTITY: DATE: CUSTODIAN OF RECORDS: PHONE: ADDRESS (form will be returned to this address): I hereby certify that the records listed below have met the retention requirements established by the Office of the Public Records Administrator in the form of approved records retention schedules. No records listed, in our opinion, pertain to any pending case, claim, or action. GOVERNMENT AUTHORIZATION CUSTODIAN OF RECORD (type or print): SIGNATURE (Custodian of Record): DATE: HEAD OF MUNICIPALITY (type or print): SIGNATURE (Head of Municipality): DATE: EDUCATION AUTHORIZATION SUPERINTENDENT OF SCHOOLS (type or print): SIGNATURE (Superintendent of Schools): DATE: SCHEDULE & SERIES # (e.g., M1-080) RECORDS SERIES TITLE INCLUSIVE DATES OF RECORDS VOLUME OF RECORDS (indicate cubic ft.) PROPOSED DATE OF DISPOSITION FROM THRU 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. PUBLIC RECORDS AUTHORIZATION APPROVED (Public Records Administrator): DATE: APPROVED (State Archivist): DATE: PUBLIC RECORDS NOTES: