STATE RECORDS COMMITTEE
SRC-110
APPLICATION FOR RECORDS STORAGE LEASE APPROVAL
1. AGENCY
2. ADDRESS
3. CONTACT
4. RECORDS SERIES TO BE STORED (Include series title and schedule number)
5. VOLUME OF RECORDS (Cubic feet or type and number of containers)
6. DATE SPAN
7. LOCATION OF PROPOSED STORAGE
8. ANNUAL COST OF LEASE
9. PERIOD FOR WHICH APPROVAL IS REQUESTED
Agency Head/Designee Signature Date
FOR STATE RECORDS COMMITTEE ONLY Reviewed by: Date: SRC Agenda for: NOTES:
STATE RECORDS COMMITTEE ACTION Approved for period Disapproved through
Chairman, State Records Committee
Date
Send original application to Department of Archives and History, Division of Records Management, P.O. Box 571, Jackson, MS 39205-0571