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FOR USE BY THE CITY OF BREMERTON
Public Records Destruction Log
Request for In -Hous Des
To comply with RCW 40 14 060, WAC 434 - 610 -070, and WAC 434 - 640 -010, 020, and 030, it is vital
that public records be destroyed according to their approved retention periods Therefore, the
purpose of this form Is to verify compliance and reasonable accountability proving specific public
records have clearly met approved retention penods°for disposal. Please fill out this form for public
records disposal In -house with an approved retention period greater than 1 year. THE RETENTION
PERIOD FOR THIS FORM IS PERMANENT AS STATED IN THE LOCAL GOVERNMENT
GENERAL RECORDS RETENTION SCHEDULE (GS5 -09 -06).
DATE I DIVISIONISECTION RECORDS OFFICER
—
10-11 Le � - Pros ec jov
BOX NUMBERS RECORDS SERIES DAN INCLUSIVE DATES RETENTION PERIOD DATE DESTROYED
•
GG52' F 1 110? - �I l0 3
All public records listed have been Identified to be at the end of their designated retention period,
have no need to be retained for audits, lawsuits, public records request or program requirements and
shall be destroyed
The individual who is responsible for destroying.the listed records must sign below prior to the Records Officer signature
approval
Employee Signature
Date " t O — 1 t
Employee Name (Please print clearly) L
The Records Officer must sign the approval of this request prior to the destruction of the listed records
Records Officer Signature Date
THIS FORM IS MAINTAINED BY THE CITY CLERK'S OFFICE AND CANNOT BE ALTERED IN ANYWAY