HomeMy WebLinkAboutMUNI COURT - 07/28/2015 �
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) Agenty Retords
Date Method of
Description Minimum
�Records Series Records Retention Minimum Retention Period Box/Item numbers, Dates Covered Destruction(See
Records Series Title . DAN Schedule ( Retention
volume,etc.) Met examples below')
Source Records- GS50-09-14 CORE 3.1 Verification of Successful DM52-06B-01 June 1,2015-July 20,2015 07-20-15 Secure shred bin
Images(Non- Rev. 1 Conversion for outside
Archival) contractor
shredding
Uniform Citation, DM52-06A- District& 3 years Closed Jan 1-Dec 31,2009 12-31-12 Secure shred bin
Complaint,Court 01 Municipal Courts for outside
Docket&Case File Retention contractor
(DV Cases) Schedule-V6 shredding
*Examples of inethods of destruction:electronic deletion,in-house OR outside contractor shredding,secure recycling,other(describeJ
Statement: The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonab/y anticipaied 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:7�C..L�1 n''� ���{��i�r'� Printed Name: 1 !(y Ll�Y'1 ��S�1'� Division: r��F']1 CL.�L�_��11J�'�'
The Records Manager must sign approval of t quest prior�o the destruction of t e listed records:
� �� p� � c ��'/�
Records Manager Signature: Printed Name: ��V w��- ��1�[�. Date Approved: �
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: �a.l.l.T'1�) '�' �C..r/J�'�1 Printed Name:_��,d,�� �tJ�s�� Date Records Destroyed: �-��'�1 S
Vendor Business Name(if used): Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
The retention and disposition action for this Public Records Destrudion Log is"Retain for the life of the aqency"pursuant to CORE series G550-09-06.
Form Revised 05/06/2014
o L� M�� Mobil� CERTIFICATE OF DESTRUCTION
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; ��� %��i�����%��� 2910 Hogum Bay Rd �p��a �o
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�/////,O///////%i1'�%//O/%/%///////,U////yi'�O//O//////%/l%// Olympia Wa 98516 �,
E-Mail: ims@wcnx.org � • �
Name: CO OP MUNICIPAL COURT-BREMERTON Phone: 1-877-898-0112 ,�, � ��~
Address: 550 PARK AVE Fax: 1-360-486-2467 °%��� No.�
City: BREMERTON , 98337 . ,
Phone: 360-473-5242 Account#: 2185-g52778-705 Route Id: SN92
Request: RWAUTO Invoice Date: 7/28/2015 Invoice#: 1170562
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 o� 2.77
Driver Signature: f.�+ Date:��8'�� Truck
Customer Signature: Date: Time