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Name of Municipality:    ________________________________________________________________

 

Contact Person/Title:    _______________________________________________________________

 

Mailing Address:     ____________________________________________________________________

 

Telephone:  ____________________________     E-Mail:     ___________________________________

 

Local Exceptions:

(List and provide basis and description of any local exceptions for records retention periods that are specified by local ordinance, Home Rule Charter provision, formal direction of the governing body, etc., that differ from those set out in the Model Municipal Records Retention Schedule. Use additional pages if needed.)

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The above municipality hereby requests approval from the Colorado State Archives to follow the Model Municipal Records Retention Schedule revised March 27, 2007, with the local exceptions indicated.

 

 

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Signature of Authorized Municipal Representative

 

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Date of Submittal of Request for Approval

 

 

Mail Approval Request Form to:  Mr. Terry Ketelsen, Colorado State Archivist, 1313 Sherman Street, Room 1B-20, Denver, CO  80203.  For further information, contact the Colorado State Archives at (303) 866-2550.

 

 

COLORADO STATE ARCHIVES APPROVAL

 

Approved By:  _______________________________________________________________________

 

Date of Approval: ____________________________________________________________________