1.         Requestor __________________________________      2.    Date    ________________________


3.         Selector   ___________________________________     4.    Phone# _______________________


5.         Library     ___________________________________     6.   Institution _____________________


7.               Reason for deaccession:


       To be retained in Special Collections


       Withdraw & replace

       Withdraw & not replace

            Selector’s signature: ­­­­­­­­­­­­­­­_______________________________________________

            (To show compliance with the Persistent Policy, the Selector’s signature is required.)­­­­­­­


 8.        Bibliographic Information:  Attach a copy of the record or fill in the following information:                                                                                                                            

a.      Title of item or set                                                                                                   

b.      Call Number:                           c.         Shelving Unit:



9.               Item Information:   Indicate which one of the three deaccessioning options you are requesting for this title:


                Item(s) to be deaccessioned are lost.

            Complete 10 a & b for each item.


         Item(s) to be deaccessioned currently located at NRLF.

Complete 10 a & b for each item.


                Item(s) to be deaccessioned currently in the hands of owning unit staff or other authorized staff.   Requestor will keep the item(s) and do the following for each physical item:


a.         Remove the NRLF bar code and attach it in 10 (a).

          b.         Indicate any vol. information in 10 (b). 

                c.         For volumes, record the spine width (to the nearest 1/4" rounding down),                               For non-book items (boxes, packages, bundles, etc.), record the dimensions  (LxWxH) in 10 (c).


 10.                        (a)                                                                 (b)                                                                    (c)

  Barcode #/Label                                                    Vol info.                                                    Spine Width (nearest ¼”)                                                                                                                                                                                                                         


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Form:  NRLF/Dep Svcs 07/01/09