Records Transfer Sheet

To transfer records to the State Records Center, this form must be submitted once
per record series. List each box and include all the data requested. Boxes must follow
our transfer procedures. We will contact you about delivery times after this form is
received. If you have questions, you may email the Records Center at
recordscenter@utah.gov or call 975-4016. We are located at 2341 South 2300 West,
West Valley City, UT, 84119-2021.

Agency Information

Agency Name:
Mailing Address:
Records Officer Name:
Records Officer Phone:
Person Submitting Form:
Email of Person Submitting:

Record Series Information

Series Number:
Series Title:
Inclusive Dates of Records Being Transferred (Month/Year):	from to
Total Boxes to be Transferred:
Transfer Includes Non-Paper Records:

Description of Records Being Transferred

For each box you are going to transfer, indicate your agency box number, the dates of what is in the box (from and to, in month/year format), and a summary of the box contents. There is no need to list each file in each box, however ranges of box contents are very helpful. Line numbers have been added for your convenience. Add as many lines to the form as you have boxes.

Example

Line, Your Box #, Dates of Contents (from and to, by month/year), Box Contents Summary (no need to list files) 1. 2004-1, from 8/1998 to 8/2000, invoices 100-200 2. 2004-2, from 9/2000 to 9/2002, invoices 201-300 3. 2004-3, from 10/2002 to 10/2004, invoices 301-400

To ease data entry, you may compile your list in word processing software, copy it (select the text with your mouse and hit Ctrl-c) and then paste it in the textbox below (Ctrl-v). Do not include a list of files with the boxes. Do include a range of contents per box.

Line, Your Box #, Dates of Contents (from and to, by month/year), Box Contents Summary (no need to list files): 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. add more lines as necessary

This page was last updated August 1, 2008.