REQUEST FOR APPROVAL OF DIGITAL FORM
INDIANA COMMISSION ON PUBLIC RECORDS
State Form 48874 (4-98)
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.
Name of agency
Name of Forms Coordinator
Signature of Forms Coordinator
Coordinator's telephone number Coordinator's E-mail address
tate Form number
Title of form:
Was the art work created by Forms Management (check one box)?
If no, complete the following for our records:
Software used for creation
Operating system (check one box)
ow will form be stored (check one box)?
Forms Online Catalog
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's telephone number
Analyst's E-mail address
DISTRIBUTION: White - Forms Management; Canary - Agency Forms Coordinator