A State Records Disposal Certificate must be filed with and approved by the State Records Commission before any records may be destroyed. A State Records Disposal Certificate form can be downloaded in Adobe Acrobat format. The form can be completed using Adobe Acrobat Reader 3.0 or later in your web browser or the file can be saved to disk and used with Adobe Acrobat Reader 3.0 outside your web browser. Macintosh and Windows versions of Acrobat Reader may be downloaded free of charge from Adobe.

• To use the form in your web browser with Adobe Acrobat Reader 3.0 or later, simply click on the link below.
• To save the file to disk, right click on the link below and choose a download location. After the file has been saved to disk, you can open the form in Acrobat Reader 3.0 or later and complete it at any time.
• If you need help in filling out this form or need a paper copy sent to your agency, call (217) 782-2647.

Instructions for Completing a Records Disposal Certificate

When you open the State Records Disposal Certificate form in Adobe Acrobat Reader, the cursor will be located at the first point at which data data should be entered. Use the Tab key to move to the various data entry points or place your cursor where you would like to enter data.

Data Entry Points

• Application Number
  On the line in the upper right-hand corner of the form, enter the record application number from the Application for Authority to Dispose of State Records which lists the records to be disposed of. This number will automatically be filled in at the bottom of the form.
   
• Agency
  Enter the official designation for the agency.
   
• Division, Bureau, Section
  Enter the secondary administrative division of the agency, whether known as division, bureau, office or section.
   
• Address
  Enter the address of the agency.
   
• Item Number from Application
  Enter the item number from the Application for Authority to Dispose of State Records for each individual item to be disposed of.
   
• Title of Record Series
  Enter the title of each record series to be disposed of.
   
• Inclusive Dates
  List the beginning and ending date span for each record series to be disposed of.
   
• Cubic Feet to be Destroyed
  List the number of cubic feet of records for each record series to be disposed of.
   
• Disposal Date
  Enter the date on or after which the records will be disposed of.

Print the completed State Records Disposal Certificate form in Adobe Acrobat Reader. At the bottom of the form, the person requesting disposal should sign and date the disposal certificate. Please also indicate the title of the person requesting disposal.

Prepare one original and two duplicate copies of the State Records Disposal Certificate. Send the original and one of the duplicate copies to the State Records Commission, Illinois State Archives, thirty (30) days prior to the disposal date. Retain one of the duplicate copies for your file.

Do not dispose of materials until one copy of the State Records Disposal Certificate is returned to your agency signed by the Chairman of the State Records Commission, in compliance with Section 4400.40(b) of the rules of the State Records Commission.

Download a State Records Disposal Certificate

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