AAA ARCHIVES RECORDS REQUEST 1. 2. 3. 4. Department Division Agency Name Account Number 5. 6. 7. Requested By Phone No. Date 8. Pick-up/Delivery Address SERVICE REQUESTED Temporary File Withdrawal Deliver to Office (see section 8) Temporary Box Withdrawal Pick-up/Return boxes or files (see section 8) Review at Records Center Other: Permanent Withdrawal ITEMS REQUESTED BARCODE NO. Printed Name Signature
AAA ARCHIVES RECORDS REQUEST 1. Department 2. Division 3. Agency Name 4. Account Number 5. Requested By 6. Phone No. 7. Date 8. Pick-up/Delivery Address SERVICE REQUESTED Temporary File Withdrawal Temporary Box Withdrawal Review at Records Center Permanent Withdrawal Deliver to Office (see section 8) Pick-up/Return boxes or files (see section 8) Other: ITEMS REQUESTED BARCODE NO. Printed Name Signature
RIMS-007-11-02-RecordsRequestAAA.docx