STATE OF ALASKA
Alaska State Archives
PO Box 110525
395 Whittier Ave
Juneau, AK 99811-0525
T: (907) 465-2241 / TRANSMITTAL RECEIPT
TRANSFER OF PUBLIC RECORDS TO
THE ALASKA STATE ARCHIVES / Accession #: ______
Date Received/By: ______
RG/Series #: ______
1. Dept. / 2. Department / 3. Division / 4. Section/Unit
5. Physical Location of Records / Contact Name / Phone #

7. DESCRIPTION OF RECORDS

7A. Series Title / 7B. Inclusive Dates
7C. Retention Schedule & Item #’s / 7D. File index, code or manual available?
Yes No
7E. Series Description (Include information regarding content, order, digital file types, etc.)
8. Total # of Containers Transferred or Digital Volume (e.g. gigabytes):
Format of Records: (Check each type that applies)
A. paper documents
B. maps, blueprints, engineering drawings
C. digital materials / D. photographs, slides, negatives
E. microforms
F. moving image recordings / G. audio recordings
H. computer disks/magnetic tapes
I. other ______
(Archives Use Only, Box #’s) / Transfer List #(s)
Total Cubic Feet ______
Total Size GB/TB ______(digital only)
Physical Condition of Records (Note damage, unusual wear, or viruses found)
10. Restrictions on Use
None Yes. Cite applicable statute or regulations:
11. The above described public records are transferred to the official custody of the Alaska State Archives under AS 40.21.
11A. Transferring Agency:
I authorize the transfer of records hereon described.
______
Signature Date / 11B. Alaska State Archives:
I accept custody of records herein described.
______
Signature Date
Typed Name Title / Typed Name Title
State Archivist

Transmittal Receipt (12/2016)