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Get Service Request Form - Mississippi Department Of Archives And ...

Equest for SRC Service 1. Agency Name 3. Agency Contact 2. Agency Location 4. Telephone Number FOR SRC USE ONLY 5. Date Completed 6. Remarks Completed by Date/Time Completed Notes: Records Delivered Records Returned 7. TYPE OF SERVICE REQUESTED Cartons Delivered Film/Tapes Delivered Film/Tapes Picked Up 8. REFERENCE REQUEST a. Temporary Loan a. Item No. 9. Receipt for records service Signature b. Copy of Records b. Description c. Information from Records c. Accession No. Date.

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