HomeMy WebLinkAboutMUNI COURT - 10/27/2015 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
Records Series Records Retention Description Minimum
Records Series Title Minimum Retention Period (Box/Item numbers, Dates Covered Destruction(See
DAN Schedule _ volume,etc.) Re Met��� examples below')
Source Records— GS50-09-14 CORE 3.1 Verification of Successful DM52-06B-01 Closed August 16, 2015— 10-21-15 Secure shred bin
Images(Non- Rev. 1 Conversion October 21,2015 for outside
Archival) contractor
shredding
Uniform Notice of DM52-06B- District& 3 years Closed August 1—September 9-30-15 Electronic Copy
Infraction,Court 01 Municipal Courts 30, 2012 Deleted
Docket,&Case File Retention
Schedule—V6
Uniform Citation, DM52-06A- District& 3 years Closed September 1-30, 2012 9-30-15 Secure shred bin
Complaint,Court O1 Municipal Courts for outside
Docket&Case File Retention contractor
Schedule—V6 shredding
*Examples of inethods of destruction:eledronic deletion,in-house OR ouiside contractor shredding,secure recycling,oiher(describeJ
Statement: The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonab/y 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: �I �[1 LlJ'Y7 ��[�/1r1 Printed Name:_�� �1�� 1 vQi) �[��� Division:l � �1Sn 1�- c„f��`l�l..�'�'
The Records Manager must sign approval of s equest.prior to the destruction of trhe listed records:
Records Manager Signature: � Printed Name: `�\��/Lv1'C. �1.. � (.-v��� Date Approved: /V� �� ��S
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: �GYI printed Name:��.�1 )Yl ' V IL�I�}� Date Records Destroyed: ���a��` 'S
Vendor Business Name(if used): Phone:
Form Revised OS/06/2014
City of Bremerton Public Records Destruction Log
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.
Form Revised OS/06/2014
' ��i MC' MO�I�C�i CERTIFICATE OF DESTRUCTION
- � � , , � �FOR IWFQ �
����j � �/G 2910 Hogum Bay Rd ,��� �y
� "''% j��'�%r���'�%jj//j�j Olym pia W a 98516 �� �
�%%G �i/%/�i���G�/�i, ��/G.� E-Mail: Ims@wcnx.org � � � o
%%%%%%//�//%%/%%///%/////O/%/%////////%/%//////%�//%i/// Phone: 1-877-898-0112 , ��
Name: CO OP MUNICIPAL COURT-BREMERTON Fax: 1-360-486-2467 �o , �c
Address: 550 PARK AVE �'�"ti� e���
City: BREMERTON , 98337 - '
Phone: 360-473-5242 Account : 2185-952778-705 Route Id: SN92
Request: RWAUTO Invoice Date: 10/27/2015 Invoice #: 1184298
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 89
Driver Signature: �"'�� Date:/'o�--Z 7-r` Truck
Customer Signature: Date: Time