State Form 48874 - Request For Approval Of Digital Form
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1REQUEST FOR APPROVAL OF DIGITAL FORM
INDIANA COMMISSION ON PUBLIC RECORDS
State Form 48874 (4-98)
INSTRUCTIONS:
Submit digital copy of the form on diskette with this completed request to the INDIANA COMMISSION ON PUBLIC
RECORDS - 402 W WASHINGTON ST RM W472 - INDIANAPOLIS IN 46204-2739. Requests for original design or revisions must follow
the standard forms revision process using State Form 36040 - REQUEST FOR APPROVAL OF NEW / REVISED FORM prior to submitting
the form for addition to the State Forms Online Catalog. State Forms listed on the Catalog are for use by state and local government
agencies, businesses and the general public.
AGENCY INFORMATION
Agency number
Name of agency
Division
Name of Forms Coordinator
Signature of Forms Coordinator
Date
Coordinator's telephone number Coordinator's E-mail address
Agency address
METADATA
tate Form number
Current Revision
S
Title of form:
Was the art work created by Forms Management (check one box)?
Yes
No
If no, complete the following for our records:
Software used for creation
Version
Operating system (check one box)
IBM (PC)
Macintosh
Other _______________________________
ow will form be stored (check one box)?
Forms Online Catalog
Forms Database
H
TO BE COMPLETED BY ICPR
Approved. Attached is a printed sample of your form in PDF format, please review this form printed from a PDF file for
accuracy and return to Forms Management.
Not approved for the following reasons:
Analyst
Analyst's telephone number
Analyst's E-mail address
Date
DISTRIBUTION: White - Forms Management; Canary - Agency Forms Coordinator
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