Utah Department of Administrative Services

Division of Archives & Records Service

Digital to Microfilm Transfer

Agency Information

Name of person submitting form:
Agency:
Email:
Phone:

Record Series Information

Series Number:
Series Title:
Date or File Range for this submission is from to

Roll Information

Scanner Number:
Roll Number: 
How Many Images Are Being Transferred (including all pages in multi-page TIFF files):
Include Blipping of Images (optional):
Include Labeling of Images (optional):
Film Size: 16 mm, portrait
35 mm, portrait
35 mm, landscape
Special Instructions: