State Form 30505 "Request for Permission to Destroy or Transfer Certain Public Records (Pr-1)" - Indiana

What Is State Form 30505?

This is a legal form that was released by the Indiana Archives and Records Administration - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2015;
  • The latest edition provided by the Indiana Archives and Records Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of State Form 30505 by clicking the link below or browse more documents and templates provided by the Indiana Archives and Records Administration.

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Download State Form 30505 "Request for Permission to Destroy or Transfer Certain Public Records (Pr-1)" - Indiana

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INDIANA ARCHIVES AND RECORDS ADMINISTRATION
REQUEST FOR PERMISSION TO DESTROY OR
402 West Washington Street, Room W472
TRANSFER CERTAIN PUBLIC RECORDS (PR-1)
Indianapolis, Indiana 46204
State Form 30505 (R6 / 6-15)
Telephone: 317-232-3380
cty@iara.in.gov
INSTRUCTIONS:
1. Prepare in quintuplicate (five (5) copies).
2. The original and three (3) copies must be filed with the County Commission of Public Records and a copy retained by the originating agency.
3. Upon approval by the County Commission, the Secretary must forward one (1) copy to the Indiana Archives and Records
Administration at the above address; one (1) copy to the county historical society (if any); and retain the original and one (1) copy for
sixty (60) days, during which time the records may be procured by an active genealogical or historical society of the county or by the
Indiana Archives and Records Administration, State Archives Division.
4. Upon the expiration of sixty (60) days the copy retained shall be forwarded to the agency, as authority to dispose of the records in
accordance with the action thereon by the County Commission.
5. The original shall be preserved as a part of the minutes of the County Commission.
RECORDS MEASUREMENT TABLE
1 Archives box (10" x 12" x 15") inside = 1 cubic foot of records
1 Linear foot of 8 1/2" x 14" documents = 1 cubic foot
1 Letter size file drawer = 1 1/2 cubic feet of records
1 Linear foot of 8 1/2" a 11" documents = 4/5 cubic feet
1 Legal size file drawer = 1 1/2 cubic feet of records
1 Linear foot of tab cards = 1/6 cubic feet
1 Number 11 record transfer box = 2 cubic feet of records
1 Linear foot of 3" x 5" cards = 1/9 cubic feet
TO BE COMPLETED BY THE ORIGINATING AGENCY OR OFFICE.
Name of government agency
Date (month, day, year)
Address of government agency (number and street, city, state, and ZIP code)
Name of contact person
Telephone number
E-mail address
(
)
Type of request (check one)
Request to destroy
Request to microfilm and destroy
Request to destroy previously microfilmed originals
Request to transfer to: ________________________________________________________________________________
TO: Secretary, Commission of Public Records, of _____________________________________ County, Indiana
VOLUME OF RECORDS
DATE OF RECORDS
NAME OR DESCRIPTION OF RECORDS
(See records measurement table.)
(month, day, year)
All of the above records have met their retention requirements in an applicable schedule as of January 1, of the present year. All records requiring audit
have been audited by the State Board of Accounts for the period indicated; the report of the audit is on file and does not show any exceptions taken or
unsettled charges.
Approved by:
Title
Date (month, day, year)
Requested by:
Title
Date (month, day, year)
Page _____ of _____
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INDIANA ARCHIVES AND RECORDS ADMINISTRATION
REQUEST FOR PERMISSION TO DESTROY OR
402 West Washington Street, Room W472
TRANSFER CERTAIN PUBLIC RECORDS (PR-1)
Indianapolis, Indiana 46204
State Form 30505 (R6 / 6-15)
Telephone: 317-232-3380
cty@iara.in.gov
INSTRUCTIONS:
1. Prepare in quintuplicate (five (5) copies).
2. The original and three (3) copies must be filed with the County Commission of Public Records and a copy retained by the originating agency.
3. Upon approval by the County Commission, the Secretary must forward one (1) copy to the Indiana Archives and Records
Administration at the above address; one (1) copy to the county historical society (if any); and retain the original and one (1) copy for
sixty (60) days, during which time the records may be procured by an active genealogical or historical society of the county or by the
Indiana Archives and Records Administration, State Archives Division.
4. Upon the expiration of sixty (60) days the copy retained shall be forwarded to the agency, as authority to dispose of the records in
accordance with the action thereon by the County Commission.
5. The original shall be preserved as a part of the minutes of the County Commission.
RECORDS MEASUREMENT TABLE
1 Archives box (10" x 12" x 15") inside = 1 cubic foot of records
1 Linear foot of 8 1/2" x 14" documents = 1 cubic foot
1 Letter size file drawer = 1 1/2 cubic feet of records
1 Linear foot of 8 1/2" a 11" documents = 4/5 cubic feet
1 Legal size file drawer = 1 1/2 cubic feet of records
1 Linear foot of tab cards = 1/6 cubic feet
1 Number 11 record transfer box = 2 cubic feet of records
1 Linear foot of 3" x 5" cards = 1/9 cubic feet
TO BE COMPLETED BY THE ORIGINATING AGENCY OR OFFICE.
Name of government agency
Date (month, day, year)
Address of government agency (number and street, city, state, and ZIP code)
Name of contact person
Telephone number
E-mail address
(
)
Type of request (check one)
Request to destroy
Request to microfilm and destroy
Request to destroy previously microfilmed originals
Request to transfer to: ________________________________________________________________________________
TO: Secretary, Commission of Public Records, of _____________________________________ County, Indiana
VOLUME OF RECORDS
DATE OF RECORDS
NAME OR DESCRIPTION OF RECORDS
(See records measurement table.)
(month, day, year)
All of the above records have met their retention requirements in an applicable schedule as of January 1, of the present year. All records requiring audit
have been audited by the State Board of Accounts for the period indicated; the report of the audit is on file and does not show any exceptions taken or
unsettled charges.
Approved by:
Title
Date (month, day, year)
Requested by:
Title
Date (month, day, year)
Page _____ of _____
ACTION BY THE COUNTY COMMISSION OF PUBLIC RECORDS
TO (name of government agency):
You are hereby notified that your request to destroy or otherwise dispose of the public records listed thereon was approved by the County Commission of
Public Records at a meeting held this date, subject to the following limitations or exceptions:
In the event that a genealogical or historical society in or of the county, or the Indiana Archives and Records Administration, State Archives Division, does
not procure all or part of these public records within the sixty (60) day period required by IC 5-15-6-7, these public records may be destroyed or otherwise
disposed of by authority of the County Commission of Public Records.
Signature of Chairman of County Commission of Public Records
Date signed (month, day, year)
ATTEST - Signature of Secretary
Date after which public records may be destroyed
(Sixty (60) days after above date)
NOTIFICATION BY GENEALOGICAL OR HISTORICAL SOCIETY OR
INDIANA ARCHIVES AND RECORDS ADMINISTRATION, STATE ARCHIVES DIVISION, TO PROCURE RECORDS
You are further notified that:
1 . No written statement has been received from any genealogical or historical society or the Indiana Archives and Records Administration,
State Archives Division, to procure any of such records.
2. A written statement has been received from _________________________________________________________________________
of its intent to procure the following records:
Signature of secretary
Date signed (month, day, year)
Page _____ of _____
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