3. RECORDS DISPOSAL REQUEST
5. To:
   SHELBY COUNTY PUBLIC RECORDS COMMISSION 980A NIXON DR. MEMPHIS, TENNESSEE 38134 901-222-8175
6. No.
   For PRC Use Only
8. FROM THE OFFICE OF:*
9. CONTACT:*
11. ADDRESS:*
12. TELEPHONE NO.*
14. LOCATION OF RECORDS (include building and floor):*
16. PLEASE COMPLETE THE FOLLOWING INFORMATION ON ITEMS 1, 2, 3, & 4
18. 1
    DESCRIBE RECORD IN COMPLETE DETAIL, INCLUDING SERIES TITLE, DATES AND IF INDEXES ARE INCLUDED. PLEASE USE A SEPARATE DISPOSAL REQUEST ON EACH SERIES OF RECORDS.
20. CTAS#, VOLUME, FROM, TO*
22. CTAS#, VOLUME, FROM, TO
24. CTAS#, VOLUME, FROM, TO
26. CTAS#, VOLUME, FROM, TO
28. 2
    RECORD QUALITY/RETENTION PERIOD:
30. 1. ORIGINAL - PERMANENT
32. 1. ORIGINAL - WORKING
33. YEAR RECORD
    YEAR RECORD
35. 1. ORIGINAL - TEMPORARY
36. YEAR RECORD
    YEAR RECORD
38. 1. DUPLICATE - WORKING
39. YEAR RECORD
    YEAR RECORD
41. Original Located:
43. 3
    RECORD DISPOSITION
44. 1. DIGITAL
    2. MICROFILMED
    3. PAPER ONLY
    4. SCANNED
46. 4
    APPROVAL
47. 1. CONTINUING APPROVAL
    2. ONE-TIME APPROVAL
51. DATE*
    DATE
52. SIGNATURE*
53. TITLE*
55. SUBSCRIBED AND SWORN TO BEFORE ME, THIS*
56. DAY OF*
57. 20 _ _*
59. NOTARY
60. NOTARY SEAL
62. MY COMMISSION EXPIRES
66. THE ABOVE LISTED RECORDS HAVE BEEN REVIEWED AND ARE READY FOR DISPOSAL.
68. COUNTY ATTORNEY'S OFFICE
69. DATE
    DATE
73. 1. APPROVED
    2. REJECTED
    3. OTHER
74. PLEASE MENTION IF OTHER
76. PUBLIC RECORDS COMMISSION, CHAIRMAN*
77. DATE*
    DATE
79. PUBLIC RECORDS COMMISSION, SECRETARY*
80. DATE*
    DATE
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83. Email address

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