Utah Department of Administrative Services

Division of Archives & Records Service

Digital to Microfilm Transfer

To transfer images to the Archives for writing to microfilm, this form must be submitted once per film roll. This step follows the request and confirmation of a work order. If you have questions, please contact the preservation manager.

Agency Information

Name of person submitting form:

Record Series Information

Series Number:
Series Title:
Date or File Range for this submission is from to

Roll Information

Scanner Number:
Roll Number: 
How Many Images Are Being Transferred (including all pages in multi-page TIFF files):
Include Blipping of Images (optional):
Include Labeling of Images (optional):
Film Size: 16 mm, portrait
35 mm, portrait
35 mm, landscape
Special Instructions: