Form VSARA-12 Request to Use the State Records Center - Vermont

Form VSARA-12 is a Vermont Secretary of State form also known as the "Request To Use The State Records Center". The latest edition of the form was released in March 1, 2018 and is available for digital filing.

Download a PDF version of the Form VSARA-12 down below or find it on Vermont Secretary of State Forms website.

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VSARA-12
Rev. 03/2018
Vermont State Archives and Records Administration
Office of the Secretary of State
1078 US RTE 2, Middlesex ● Montpelier, VT 05633-7701 ● Tel: (802) 828-3700 ● Fax: (802) 828-3710
REQUEST TO USE THE STATE RECORDS CENTER
The State Records Center provides low-cost, secure storage for paper records that must be maintained for
audit, fiscal, legal, or administrative needs, but are no longer used frequently enough to justify storing the
records on-site, which is generally more expensive. For records stored in the State Records Center, both
legal control and control of access to the records are retained by the agency until the records have met the
retention requirements stated on a record schedule approved by the State Archivist. After retention
requirements are met, the State Records Center will dispose of the records in accordance with the
disposition requirements stated in the record schedule (destruction or transfer to the State Archives).
Sender (Records Officer):
Date:
Agency/Department/Division/Office:
Please include a copy of your agency/dept.’s internal records management policy when submitting this form.
For VSARA Use Only
Old Series No.
Record Schedule
Schedule Title
(if applicable)
New Series ID.
Archives
GRS-1181.1059
Professional Licensing Files
SE-047
Page
of
Signature of Records Officer
Date Signed
Please send all completed forms to the address above (Attn.: Agency Services) or send by email to
sos.rim@vermont.gov. Forms submitted by email must be sent directly from the records officer’s email account.
Once the request is received, a VSARA records and information management specialist will review the request and contact the
Records Officer with any questions. If approved, new series ID number(s) will be provided to the Records Officer in the form of
a Series Report and the transfer of records can begin under current VSARA procedures. Records appraised as permanent archival
also require a Legal Custody Transfer Agreement (Form VSARA-21) to be on file as the records will be automatically transferred
to the State Archives after retention requirements have been met.
VSARA-12
Rev. 03/2018
Vermont State Archives and Records Administration
Office of the Secretary of State
1078 US RTE 2, Middlesex ● Montpelier, VT 05633-7701 ● Tel: (802) 828-3700 ● Fax: (802) 828-3710
REQUEST TO USE THE STATE RECORDS CENTER
The State Records Center provides low-cost, secure storage for paper records that must be maintained for
audit, fiscal, legal, or administrative needs, but are no longer used frequently enough to justify storing the
records on-site, which is generally more expensive. For records stored in the State Records Center, both
legal control and control of access to the records are retained by the agency until the records have met the
retention requirements stated on a record schedule approved by the State Archivist. After retention
requirements are met, the State Records Center will dispose of the records in accordance with the
disposition requirements stated in the record schedule (destruction or transfer to the State Archives).
Sender (Records Officer):
Date:
Agency/Department/Division/Office:
Please include a copy of your agency/dept.’s internal records management policy when submitting this form.
For VSARA Use Only
Old Series No.
Record Schedule
Schedule Title
(if applicable)
New Series ID.
Archives
GRS-1181.1059
Professional Licensing Files
SE-047
Page
of
Signature of Records Officer
Date Signed
Please send all completed forms to the address above (Attn.: Agency Services) or send by email to
sos.rim@vermont.gov. Forms submitted by email must be sent directly from the records officer’s email account.
Once the request is received, a VSARA records and information management specialist will review the request and contact the
Records Officer with any questions. If approved, new series ID number(s) will be provided to the Records Officer in the form of
a Series Report and the transfer of records can begin under current VSARA procedures. Records appraised as permanent archival
also require a Legal Custody Transfer Agreement (Form VSARA-21) to be on file as the records will be automatically transferred
to the State Archives after retention requirements have been met.

Download Form VSARA-12 Request to Use the State Records Center - Vermont

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