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DCR- DHR- ARS- GRB -RC 10 (rev.5 /02) Reproduce this form as needed. <br />North Carolina Department of Cultural Resources <br />Division of Historical Resources <br />Government Records Branch <br />REQUEST FOR DISPOSAL OF UNSCHEDULED RECORDS <br />TO Assistant Records Administrator <br />N.C. Division of Historical Resources <br />Government Records Branch <br />4615 Mail Service Center <br />Raleigh, NC 27699 -4615 <br />FROM Name <br />Cou ntv <br />Agency or department <br />Phone number <br />In accordance with the provisions of G.S. 121 and 132, approval is requested for the destruction of records listed below. These <br />records have no further use or value for official or administrative purposes. <br />I RECORDS TITLE I DESCRIPTION I INCLUSIVE DATES I QUANTITY I MICROFILMED? <br />No I RETENTION PEROD I <br />Requested by: <br />Signature Title <br />Approved by: <br />Signature Mayor /Head of Governing Board <br />Concurred by: , <br />(except as indicated) Signature Assistant Records Administrator <br />NC Division of Historical Resources <br />Date <br />Date <br />Date <br />73 Attachment number 1 <br />F -9 Page 173 <br />