HomeMy WebLinkAboutFINANCE - 04/16/2014 Local Government Public Records Destruction Log
The purpose of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved minimum
retention periods before being destroyed pursuant to RCW 40.14.070, WAC 434 - 610 -070, and WAC 434 - 640 -010 -020, and -030 Please fill out this form when
destroying all public records whose minimum retention is other than "Retain until no longer needed for agency business then destroy" (such as records covered in
the "Records with Minimal Retention Value" section of the Local Government Common Records Retention Schedule (CORE).
Legal Disposition Authority (taken from Records Retention Schedule) Agency Records
Description Date Method(s) of
Records Series Records Series Records Retention Minimum Destruction
Title DAN Schedule Minimum Retention Period (Box /item numbers, Dates Covered Retention (See examples,
volume, etc.) Met below *)
In house
Banking GS2011 -185 LGCR 6 years Cancelled Ck CD's 1/1/2007- 12/31/2007 6 years Shred
*Examples of methods of destruction: electronic deletion, in -house OR outside contractor shredding, secure recycling, other (describe)
Statement: The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonably
anticipated litigation or public records requests, are not needed for audit or other agency business, and shall be destroyed.
The individual responsible. or 'nvent ing the listed records must sign bello prior to the Reco rd sManager's appro ^� I r` / p Employee Signature: Printed Name: F o � d r oW n Division: Ftn0 _JJ ( 6e V_i(_c s
The Records Manager must ns'e approv this requesf prior to the destruction of the li s rec Records Manager Signatur Printed Name J& wv� ��' Bate Approved:
The person /people resnsib or th truction of records must sign upon destruction f the listed records: 1
Employee Signatur Printed Name: 1 l_A,IJ1 J Date Records Destroyed: W O
Vendor Business Name (if used): /41 Ish Pennsulo Etroce S Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
The retention and disposition action for this Public Records Destruction Log is "Retain for the life of the agency" pursuant to CORE series GS50- 09 -06.
This sample form was prepared by Washington State Archives as a courtesy to local government agencies in January, 2014.
It may be modified to meet individual agency needs.