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<br />MINNESOTA HISTORICAL SOCIETY <br />STATE ARCHIVES DEPARTMENT <br />APPLICATION FOR ONE-TIME AUTHORITY <br />TO DISPOSE OF RECORDS <br /> <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 /> <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 /> <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 /> <br /> <br />NOTE: Laws of 1971, Chapter 529, Section 3 reads as follows: β€œIt 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 a <br />manner different than prescribed by such chapter or by this act and no general or special statute enacted subsequent to <br />this act shall be construed to authorize or prevent the disposal of public records at a time or in a manner different than <br />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 /> <br /> 1. Agency or Office 2. Division or Section 3. Quantity of Records <br /> <br /> Cubic Feet <br /> <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 /> <br /> 6. I certify that the records listed on this application are accurately described, and <br />that they have no further administrative, legal, or fiscal value for this agency. <br />AUTHORIZATION: Under the authority of M.S. 138.17, it is hereby ordered that <br />The records listed on this application be destroyed, except as shown in item 7. <br /> <br /> _ _ <br />Authorized Signature (Type name below) Director, Minnesota Historical Society Date <br /> <br /> _ _ <br />Name Date Legislative or State Auditor Date <br /> <br /> _ _ <br />Title Phone Attorney General Date <br /> <br /> <br />7. Exceptions to Destruction. (For use by Records Disposition Panel). <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />8. Description of Records. Describe each record series or type of record separately. Number each series, beginning with β€œ1”. <br />A. Item No. B. Name of record, form numbers, content, usage, arrangement, original <br />duplicate, or microfilmed. <br /> <br /> <br />C. Inclusive Dates <br />FOR USE BY RECORDS PANEL <br />Application No. Date