Mail Paper File

Requester Information

Appointed records officer or records officer designee name*

Agency*

Email*

Phone number*

Record Information

Series number*

Agency box number*

Records center box number*

File name or number (leave blank to recall the entire box)

Delivery

Who should the record be delivered to?

Recipient Name (if different from records officer)

Recipient Phone (if different from records officer)

Recipient Email (if different from records officer)

Street Address*

City*

State*

Zip Code*

Special Instructions