State Form 47167 "Do Not Destroy Records" - Indiana

What Is State Form 47167?

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 47167 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 47167 "Do Not Destroy Records" - Indiana

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INDIANA ARCHIVES AND RECORDS ADMINISTRATION
DO NOT DESTROY RECORDS
INDIANA STATE RECORDS CENTER
6400 East 30th Street
State Form 47167 (R2 / 6-15)
Indianapolis, IN 46219
Telephone: (317) 591-5326
Fax: (317) 591-5328
INSTRUCTIONS:
1.
Use this form if you have received State Form 16, “Records Destruction Notification,” from the Records
Center and the records may not be destroyed due to ongoing litigation or a pending audit.
2.
Fill out this form completely and forward to the Records Center at the above address.
AGENCY INFORMATION
Reason records may not be destroyed (check one)
State Audit Pending
Federal Audit Pending
State / Federal litigation (copy of court order attached)
Other: ______________________________________________________________________________________________________________
New destruction date (month, day, year)
Signature of Agency Records Coordinator
Date of signature (month, day, year)
Printed name of Agency Records Coordinator
Reset Form
INDIANA ARCHIVES AND RECORDS ADMINISTRATION
DO NOT DESTROY RECORDS
INDIANA STATE RECORDS CENTER
6400 East 30th Street
State Form 47167 (R2 / 6-15)
Indianapolis, IN 46219
Telephone: (317) 591-5326
Fax: (317) 591-5328
INSTRUCTIONS:
1.
Use this form if you have received State Form 16, “Records Destruction Notification,” from the Records
Center and the records may not be destroyed due to ongoing litigation or a pending audit.
2.
Fill out this form completely and forward to the Records Center at the above address.
AGENCY INFORMATION
Reason records may not be destroyed (check one)
State Audit Pending
Federal Audit Pending
State / Federal litigation (copy of court order attached)
Other: ______________________________________________________________________________________________________________
New destruction date (month, day, year)
Signature of Agency Records Coordinator
Date of signature (month, day, year)
Printed name of Agency Records Coordinator