Public Document Depository Program

PUBLIC DOCUMENT DEPOSITORY PROGRAM

ANNUAL PUBLICATIONS REPORT FORM

All Louisiana state agencies, as defined by R.S. Title 25: §121.1, are required to report the agency’s publications to the Recorder of Documents. Submit this completed form annually during the month of July by email to [email protected] or send it via fax, mail, or hand-delivery to the address given at the bottom of this form. Note: list each title only once, even if multiple issues were published during the twelve month period (July 1-June 30) covered by the report (e.g., list “Minutes” only once, even if published quarterly). If a publication changes significantly (e.g., changes title, ceases publication) during the year, please promptly submit the Publication Update Form, available from the Recorder’s web page for agencies at http://www.state.lib.la.us/state- employees/depository-library-program/state-agencies.

Agency Name: Terrific State Agency Today’s Date: 7/14/2017

Your Name: Ms. Jane X Job Title: Director of Something Services

Email: [email protected] Are you the liaison officer for this Yes No Phone: 504-123-5678 agency? Liaison Name: Liaison Job Title:

Liaison Email: Liaison Phone: Secondary Contact Secondary Contact Mr. Bob Y Administrative Assistant Name: Job Title: Secondary Contact Secondary Contact [email protected] 504-123-5679 Job Email: Phone:

Select Frequency From Check All Format(s) Published Publication Title: Dropdown Menu: During Reporting Period: Minutes of board meetings Monthly Hard Copy Digital

Journal of Louisiana Something Quarterly Hard Copy Digital

Annual report Annually Hard Copy Digital

Guide to Something Important One time publication Hard Copy Digital

Manual for Citizen Constituents Irregularly--As often as needed Hard Copy Digital

Quarterly Progress Report Quarterly Hard Copy Digital

Choose an item. Hard Copy Digital

of 2 Select Frequency From Check All Format(s) Published Publication Title: Dropdown Menu: During Reporting Period: Choose an item. Hard Copy Digital

Choose an item. Hard Copy Digital

Thank you for your continued support of the Louisiana Public Document Depository Program.

RECORDER OF DOCUMENTS STATE LIBRARY OF LOUISIANA 701 NORTH 4TH STREET BATON ROUGE, LA 70802 PHONE 225.342.4929 Fax 225.219.4804

PDDP State Agency Publications Report Form Page 2 of 2