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11 MINNESOTA HISTORICAL SOCIETY <br /> STATE ARCHIVES DEPARTMENT FOR USE BY RECORDS PANEL <br /> APPLICATION FOR ONE-TIME AUTHORITY Application No. Date <br /> TO DISPOSE OF RECORDS <br /> Please note: If the records in question appear on an approved records retention schedule used by your agency, it is <br /> unnecessary to submit this form requesting approval for destruction. Contact the State Archives if you have <br /> questions. <br /> This form does not provide continuous authority to dispose of similar records and cannot be used to approve a records retention <br /> schedule. <br /> Instructions: <br /> 1. Complete original and three copies (photocopies are acceptable). <br /> 2. Complete items 1 through 6 and item 8. Use reverse side to continue records description. If more space is needed, use <br /> plain paper. <br /> 3. Send original and two copies to the State Archives Department, 345 Kellogg Boulevard West, St. Paul, MN 55102-1906. <br /> 4. Retain one copy until your approved copy is returned. The approved copy will be your authority to dispose of records. It <br /> should be retained permanently. <br /> Additional copies of this form are available on the State Archives website, www.mnhs.org/statearchives or by calling (651) <br /> 259-3260. (FAX: (651) 296-9961). Our email address is statearchives@mnhs.org <br /> NOTE: Laws of 1971,Chapter 529, Section 3 reads as follows: "It is the policy of the legislature that the disposal and <br /> preservation of public records be controlled exclusively by Minnesota Statutes, Chapter 138 and by this act,thus, no <br /> prior, special or general statute shall be construed to authorize or prevent the disposal of public records at a time or in <br /> a manner different than prescribed by such chapter or by this act and no general or special statute enacted subsequent <br /> to this act shall be construed to authorize or prevent the disposal of public records at a time or in a manner different <br /> than prescribed in chapter 138 or in this act unless it expressly exempts such records from the provision of such <br /> chapter and this act by specific reference to this section." <br /> 1. Agency or Office 2. Division or Section 3. Quantity of Records <br /> Cubic Feet <br /> 4. Location of Records 5. Laws other than M.S.138.17 that relate to the destruction or safekeeping of the <br /> records: <br /> 6. I certify that the records listed on this application are accurately described,and AUTHORIZATION: Under the authority of M.S.138.17,it is hereby ordered that <br /> that they have no further administrative,legal,or fiscal value for this agency. The records listed on this application be destroyed,except as shown in item 7. <br /> Authorized Signature (Type name below) Director,Minnesota Historical Society Date <br /> Name Date Legislative or State Auditor Date <br /> Title Phone Attorney General Date <br /> 7. Exceptions to Destruction. (For use by Records Disposition Panel). <br /> 8. Description of Records. Describe each record series or type of record separately. Number each series,beginning with"1". <br /> A. Item No. B. Name of record,form numbers,content,usage,arrangement,original C. Inclusive Dates <br /> duplicate,or microfilmed. <br /> 49 <br />