VA RECORDS CENTER AND VAULT (RC&V) REFERENCE REQUEST
NOTE: Use a separate form for each request.
TO
ACCESSION NO. BOX NUMBER
VA Records Center and Vault (RC&V) 11793 Lime Kiln Drive Neosho, MO 64850
OF
DESCRIPTION OF RECORD(S) OR INFORMATION REQUESTED
REMARKS
NATURE OF SERVICE FURNISH COPY OF RECORD(S) ONLY NAME OF REQUESTER PERMANENT WITHDRAWAL TEMPORARY LOAN OF RECORD(S) OTHER (Specify) DATE
REVIEW
COMMERCIAL TELEPHONE NO. (Include Area
TRANSFERRING FACILITY OFFICIAL (Signature and title)
DATE
NAME AND ADDRESS OF OFFICE/AGENCY (Include street address, building, room no. and ZIP Code)
FOR USE BY RC&V
REMARKS RECORDS DESTROYED
RECORDS NOT IN RC&V CUSTODY
WRONG BOX NUMBER -- PLEASE RECHECK
ADDITIONAL INFORMATION REQUIRED TO IDENTIFY RECORDS REQUESTED
MISSING (Neither record(s) or information found in container(s) specified)
RECORDS PREVIOUSLY CHARGED OUT TO (Name, office/agency and date):
DATE
SERVICE PERFORMED
TIME REQUIRED
SEARCHER'S INITIALS
VA FORM APR 1999(R)
0245
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