[Return to Table of Contents]

 

---

 

Name of DISTRICT:    ________________________________________________________________

 

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 lformal direction of the governing body, etc., that differ from those set out in the Special District Records Retention Schedule. Use additional pages if needed.)

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

The above SPECIAL DISTRICT hereby requests approval from the Colorado State Archives to follow the SPECIAL DISTRICT Records Retention Schedule revised 2011, with the local exceptions indicated.

 

 

___________________________________________

Signature of Authorized DISTRICT Representative

 

___________________________________________

Date of Submittal of Request for Approval

 

 

Mail Approval Request Form to:  Mr. George Orlowski, 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: ____________________________________________________________________