Return to: Commission on Public Records
TRANSMITTAL (Analysis)
Forms/Records Management
402 West Washington Street, Room W472
State Form 43055 (R3 / 11-95)
Indianapolis, IN 46204
Title
State Form number
Requisition number
TO (Forms Coordinator)
Agency
Date (month, day, year)
FROM (Forms Analyst / Clerk)
Telephone number
ISSUE
ACTION REQUIRED
You are using an unauthorized form. Enclosed is the prescribed form
The type of form you have submitted has been standardized for use
which you should request for printing.
by all state agencies / facilities.
Please submit a formal letter, signed by the forms coordinator and head
Our research indicates that this form has been deleted from the
of agency, requesting the reactivation of this deleted state form.
State Forms Data Base.
The form you have submitted appears to necessitate a consolidation.
Please contact the Forms Analyst concerning consolidation of this form.
The form you have submitted is used by more than one agency
Please inform the Forms Analyst if the State Form is to be standardized
/ facility.
for use throughout all agencies / all your facilities.
All revisions to this form must be reviewed and approved by their Forms
This form is primarily used by:
Coordinator ____________________________________________.
Please notify the Forms Analyst / Clerk within five (5) working days if you
The Forms Distribution Center is ready to restock this form.
need to make any revisions to the form. Should we not hear from you, the
form will be released for printing / restocking in its current version.
Additional information
DISTRIBUTION: White - Form's file; Canary - Agency