Form Slr 540 - Certification And Acceptance - Texas State Library And Archives Commission
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1
2Local Government Records Control Schedule
CERTIFICATION AND ACCEPTANCE
Section 1
USE OF FORM
Section 2
SUBMISSION OF DATA
1. Purpose of Schedule
1. Government: ____________________________________
Original Schedule
(Check if no previous records control
schedule is on file)
2. Department
: ______________________________
(optional)
Amended Schedule
3. Office
:___________________________________
(Check if this records control schedule
(optional)
replaces previous records control schedule on file)
4. Address: ________________________________________
Amendment to Schedule or Supplemental Records
City: ___________________________ ZIP code: ______
Control Schedule
5. Telephone: _________________
2. Number of Pages: ________
6. Email
: ____________________________
(optional)
Section 3
LOCAL GOVERNMENT CERTIFICATION
Form
The attached document is submitted for filing pursuant to Local Government Code §203.041. It has been approved according to the
SLR 540
ordinance, order, or plan of the local government or elective county office for which I am the Records Management Officer. I certify that the
administrative rules for electronic records, adopted under Local Government Code §205.003(a), will be followed for records subject to the
rules.
Name and Title
(print or type): ___________________________________________________________________
Signature: ____________________________________________ Date: ___________________
Texas State Library
Section 4
TEXAS STATE LIBRARY ACCEPTANCE
(to be completed by Texas State Library)
and Archives Commission
This records control schedule submitted for filing with the Texas State Library and Archives Commission has:
State and Local Records
Management Division
been accepted for filing pursuant to Local Government Code §203.043(a). A record appearing on the schedule or amendment may be
Box 12927
disposed of at the expiration of its retention period without additional notice to the director and librarian, subject to the provisions of Local
Austin, Texas 78711-2927
Government Code §203.041(d).
512-463-7610
not been accepted for filing pursuant to Local Government Code §203.043(b). See accompanying letter for explanation.
512-936-2306 FAX
SLR 540 (6/12)
Name and Title: _________________________________________________________________
Signature: ___________________________________________ Date: _____________________
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