Spreadsheet: 0bbef69b-48fc-41fe-a22d-2a24d1d58704
Sheet: Sheet1

Unnamed: 0 | STD-62 (Rev 2-07) | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Commonwealth of Pennsylvania | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28 | Unnamed: 29 | Unnamed: 30
 | Pennsylvania Historical and Museum Commission
 | Bureau of Archives and History
 | Division of Records Administration and Image Services
 | Records Disposition Report
 | This report captures the disposition and quantity of physical records being disposed of in an agency.  Physical  records means those records that are visible such as paper, microfilm, microfiche, CD's, DVD's, etc. This form should not be used for electronic records with Disposal Code 6 (delete).
 | INSTRUCTIONS:  Agency staff should complete the form and send to the Agency Records Coordinator for approval.  All entries, other than the signature and date, should be typed or computer-generated.  Upon receipt of the approved form, agency staff should then dispose of the records in accordance with the proper disposal code.  Agencies should retain this form permanently to document the legal disposition of records by the agency.
 | Special Note - quantity of records:  For digital media and film, capture the actual number of rolls, fiche, disks, etc.  For paper, capture the number of boxes.  One standard records center box = 1 cu. ft.
 | Agency |  |  |  |  |  |  |  |  |  |  | Dept. Code |  |  | Bureau/Office |  |  |  |  |  |  |  |  |  |  |  | Bureau/SAP Cost Center Code
 | Address |  |  |  |  |  |  |  |  |  |  |  |  |  | City |  |  |  |  |  |  |  |  |  |  |  | State | Zip Code
 | Name & Title of person responsible for maintaining records |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Telephone No.
 | Records Retention Schedule Item No. |  |  |  |  |  | Record Series Title |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Inclusive Dates |  |  |  |  |  | Quantity (See Special Note Above)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | From |  |  |  | To
 | (If more space is needed, use 8 1/2 X 11 sheets and attach.)
 | CERTIFICATIONS:  (Check Appropriate Block)
 | 1. |  | I hereby certify that the disposition of the records listed above is approved.
 | At the time of disposal, the records will be:
 |  |  |  | Destroyed |  |  |  |  |  |  | Transferred to Archives |  |  |  |  |  |  |  |  |  | Other Action
 | 2. |  | I hereby certify that the records listed above have been microfilmed.  The destruction of the original
 |  |  | records will be carried out in accordance with the Records Retention and Disposition Schedule, and the microfilm
 |  |  | will be maintained as the official record.
 | 3. |  | I hereby certify that the records listed above have been scanned and will be maintained in accordance with the
 |  |  | Records Retention and Disposition Schedule.
 | 4. |  | The destruction of the records listed above is NOT APPROVED for reasons stated below.
 | Agency Records Coordinator Signature |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date