HomeMy WebLinkAboutMUNI COURT - 03/24/2015 City of Bremerton 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 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 Records Retention Schedule(CORE)).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Description Date Method of
Records Series Title Records Series Records Retention Minimum
DAN Schedule Minimum Retention Period (Box/Item numbers, Dates Covered Destruction(See
volume,etc.) Retention examples below*)
Source Records— GS50-09-14 CORE 3.1 Verification of Successful DM52-066-01 Closed February 1, 2012— 02-23-15 Secure shred bin
Images(Non- Rev. 1 Conversion March 23,2015 for outside
Archival) contractor
shredding
*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 for inventorying the listed records must sign below prior to the Record's Manager approval:
Employee Signature: =!�(1l 1 7Y') -/ LD Q /Ylprinted Name: I X 1 1 ( )Y) NQ��n� Division: Co un i C U3Q_ I Cop r+
The Records Manager must Sign the approval o�thh* quest prior to-the destruction of th listed records:
In ,nom^ /f
Records Manager Signatur Printed Name: ti/Gy!''l _ r-,� Date Approved: 3 ,/L '/,5
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: -! )a LA_JT 1 ,ALJ/162-09(-Printed Name: 1 .4)1^l 11410e)10e)50n Date Records Destroyed:DD00 I CL(2tT_ COVY16
Vendor Business Name(if used): .J EE RT T-; tC HM
Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
Form Revised 05/06/2014
Le May Mobile CERTIFICATE OF DESTRUCTION
FOR Il�f�
IF/.
1 F 2910 Hogum Bay Rd
� Olympia Wa 98516 '�ox
®/fit,
!�i � �� i E-Mail: Ims@wcnx.org c
Phone: 1-877-898-0112
Name: CO OP MUNICIPAL COURT-BREMERTON Fax: 1-360-486-24670 c�
Address: 550 PARK AVE
City: BREMERTON 98337 • -
Phone: 360-473-5242 Account : 2185-952778-705 Route Id: SN92
Request: RWAUTO Invoice Date: 3/24/2015 Invoice#: 1151419
On the date shown, Designated Confidential Data was Shredded and Destroyed as per Customers Instructions.
Notes: Acct: 952778-705
Service Description Qty Rate Amount
65SC 2.00 65 GAL SHRED CART 2.77
Driver Signature: 46 Date:�-�f/r Truck
Customer Signature: Date: Time