Application for One-Time Authority to Dispose of Records (PR-1 Form)

MINNESOTA HISTORICAL SOCIETY

STATE ARCHIVES DEPARTMENT

APPLICATION FOR ONE TIME AUTHORITY

TO DISPOSE OF RECORDS

FOR USE BY RECORDS PANEL

Application No.

Date

Please note: If the records in question appear on an approved records retention schedule used by your agency, it is

unnecessary to submit this form requesting approval for destruction. Contact the State Archives if you have

questions.

This form does not provide continuous authority to dispose of similar records and cannot be used to approve a records retention

schedule.

Instructions:

1. Complete original and three copies (photocopies are acceptable).

2. Complete items 1 through 6 and item 8. Use reverse side to continue records description. If more space is needed, use

plain paper.

3. Send original and two copies to the State Archives Department, 345 Kellogg Boulevard West, St. Paul, MN 55102-1906.

4. Retain one copy until your approved copy is returned. The approved copy will be your authority to dispose of records. It

should be retained permanently.

Additional copies of this form are available on the State Archives website, www.mnhs.org/statearchives or by calling (651)

259-3260. (FAX: (651) 296-9961). Our email address is statearchives@mnhs.org

NOTE: Laws of 1971, Chapter 529, Section 3 reads as follows: “It is the policy of the legislature that the disposal and

preservation of public records be controlled exclusively by Minnesota Statutes, Chapter 138 and by this act, thus, no

prior, special or general statute shall be construed to authorize or prevent the disposal of public records at a time or in

a manner different than prescribed by such chapter or by this act and no general or special statute enacted subsequent

to this act shall be construed to authorize or prevent the disposal of public records at a time or in a manner different

than prescribed in chapter 138 or in this act unless it expressly exempts such records from the provision of such

chapter and this act by specific reference to this section.”

1. Agency or Office 2. Division or Section 3. Quantity of Records

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_______________

Cubic Feet

4. Location of Records 5. Laws other than M.S. 138.17 that relate to the destruction or safekeeping of the

records:

6. I certify that the records listed on this application are accurately described, and

that they have no further administrative, legal, or fiscal value for this agency.

Authorized Signature (Type name below)

Name Date

Title Phone

AUTHORIZATION: Under the authority of M.S. 138.17, it is hereby ordered that

The records listed on this application be destroyed, except as shown in item 7.

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_________________________________________________________________ ____________________________________________________________________

Director, Minnesota Historical Society Date

____________________________________________________________________ ____________________________________________________________________

Legislative or State Auditor Date

____________________________________________________________________ ____________________________________________________________________

Attorney General Date

7. Exceptions to Destruction. (For use by Records

Disposition Panel).

8. Description of Records. Describe each record series or type of record separately. Number each series, beginning with “1”.

A. Item No. B. Name of record, form numbers, content, usage, arrangement, original

duplicate, or microfilmed.

C. Inclusive Dates