Free Of11.PDF - Federal

REFERENCE REQUEST--FEDERAL RECORDS CENTERS

NOTE: Use a separate form for each request.

SECTION I--TO BE COMPLETED BY REQUESTING AGENCY ACCESSION NO. AGENCY BOX NUMBER RECORDS CENTER LOCATION NUMBER OF DESCRIPTION OF RECORD(S) OR INFORMATION REQUESTED BOX

FOLDER (include file number and title)

FAX form to (215)305-2038 or email to [email protected]

METRO COURIER SERVICE

Delivery Pick-up (serviced within 48 hours of request)
NATURE OF SERVICE FURNISH COPY OF RECORD(S) ONLY PERMANENT WITHDRAWAL

Rush (Order by noon, receive within 4 hours) Regular (Order by 2:00PM,receive by 3:00PM next day)
OTHER (Specify)

TEMPORARY LOAN OF RECORD(S)

REVIEW

SECTION II--FOR USE BY RECORDS CENTER REMARKS
RECORDS NOT IN CENTER CUSTODY RECORDS DESTROYED

WRONG ACCESSION NUMBER--PLEASE RECHECK WRONG BOX NUMBER-PLEASE RECHECK WRONG CENTER LOCATION--PLEASE RECHECK ADDITIONAL INFORMATION REQUIRED TO IDENTIFY RECORDS REQUESTED MISSING (Neither record(s), information nor charge card found in container(s) specified) RECORDS PREVIOUSLY CHARGED OUT TO (Name, agency and date):

DATE

SERVICE

TIME REQUIRED

SEARCHER'S INITIALS

NAME OF REQUESTER NAME AND ADDRESS OF AGENCY
(Include street address, building, room no. and ZIP Code) NSN 7540-00-682-6423 5011-108

SECTION III--TO BE COMPLETED BY REQUESTING AGENCY TELEPHONE NO. FTS DATE

RECEIPT OF RECORDS

Requester please sign, date and return this form, for file item(s) listed above, ONLY if the block to right has been checked by the Records Center.

SIGNATURE PREVIOUS EDITION USABLE

DATE
OPTIONAL FORM 11 (Rev. 7-87)
NATIONAL ARCHIVES AND
RECORDS ADMINISTRATION
36 CFR 1228.162