Designation of Local Government
Records Management Officer
Purpose: The purpose of this form is to notify the Texas State Library and Archives Commission of a
change in Records Management Officer (RMO).
Instructions: Elected officials complete Section One only; all other local governments complete
Section Two only.
Section 1 Elected County Officials ONLY
1.
County:________________________________________________________________
2.
Title of Office:___________________________________________________________
3.
Name of Officeholder:_____________________________________________________
4.
Address: ______________________________________________________________
5.
City: ________________________________
ZIP code: _______
6.
Telephone: ______________
7.
Email address (optional): _____________________________
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Signature ______________________________________________ Date: _________________
Section 2
All Other Local Government Offices
Before filling out this form, consult the Records Management policy/order/ordinance (“policy”) approved by your
governing body. If the position of the RMO has changed, or if the policy names an individual who is no longer
serving as RMO, a new policy must be filed along with this form.
1.
Government: ___________________________________________________________
2.
Position Designated in Policy: ______________________________________________
3.
Individual’s Name: _______________________________________________________
4.
Address: ______________________________________________________________
5.
City: ________________________________
ZIP code: _______
6.
Telephone: ______________
7.
Email address (optional): _____________________________
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Signature ______________________________________________ Date: _________________
Please return original, signed form within 30 days of RMO change to:
State and Local Records Management Division
Texas State Library and Archives Commission
P.O. Box 12927
Austin, TX 78711-2927
Texas State Library and Archives Commission
Box 12927
512-463-7610
State and Local Records Management Division
Austin, Texas 78711-2927
512-936-2306 FAX
SLR 504 (8/12)