HomeMy WebLinkAboutFINANCE - 09/18/2014 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 Retention Period (Box/item numbers, Dates Covered Minimum Destruction
Title DAN Schedule Retention (See examples,
volume,etc.) Met below*)
GS50-01-12 LGCR 2 Years Change ofAddress Requests 2004-2007 2009 In-house
GS50-08A-12 LGCR 6 Years Change Orders 2001-2006 2013 In-house
*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 responsiblo foi inventlevving the listed records must sign belo prior to the Records
Manager's approval:
w r CE ► I ��` anc C
Employee Signature: �� ! -- Printed Name: Division:
The Records Manager must sig approval of this request prior to the destruction of the listed records: I
Records Manager Signatur Printed Name:\ Y l/x{�hVYt �Yi\✓� Date Approved:
The person/people res ibl for 7destruction of records must sign upon destruction of the listed records:Employee Si nature: � tv`�- Printed Name: I �1��`� Date Records Destroyed:
g
Vendor Business Name(if used): 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.