HomeMy WebLinkAboutMUNI COURT - 11/23/2015 • City of Bremerton Public Records Destruction �og
'-�-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 Records
Date Method of
Descrlption Minimum
Records Series Records Retention Destructlon See
Records Series Title Minlmum Retention Period (Box/Item numbers, Dates Covered Retention
DAN Schedule volume,etc.) Met examples below')
Source Records— GS50-09-14 CORE 3.1 Verification of Successful DM52-066-01 Closed October 22,2015— 11-23-15 Secure shred bin
Images(Non- Rev. 1 Conversion November 23,2015 for outside
Archival) contractor
shredding
Uniform Notice of DMSZ-068- District& 3 years Closed January 1—April 30& 11-01-15 Electronic Copy
Infraction,Court 01 Municipal Courts October 1—31,2012 Deleted
Docket,&Case File Retention
Schedule—V6
Uniform Citation, DM52-06J- District& 3 years Closed May 1—August 31, 9-01-15 Secure shred bin
Complaint, Court 01 Municipal Courts 2012 for outside
Docket&Case File Retention contractor
(photo enforced) Schedule—V6
shredding
*Examples of inethods of destruction:eledronic 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 sha/l be destroyed.
The individual responsible for inventorying the listed records must sign below prior to the Record's Manager approval:
Employee Signature: � 1 1 SY1 -/ � SU�C71r\ Printed Name: �n..�.L�n �Qi�CJ�rI Division:� LZn�S��,l COU�"'C
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The Records Manager must sign the approval of this request prior to the destruction o . listed records:
r t� /n� '� ' ��°/'��'
Records Manager Signature: /���L w� Printed Name: Date Approved:
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The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: � �� �1 N1 �7 Printed Name: ._JQ� 17 1 �+�S�° 1 Date Records Destroyed: � ����—��
Vendor Business Name(if used): S.Q�. Q�.�Cl�[r Phone:
Form Revised 05/06/2014
• City of Bremerton Public Records Destruction Log
�� Vendor Signature: Printed Name: Date Records Destroyed:
The retention and disposition action for this Public Records Destrudion Log is"Retain for the life of the agency"pursuant to CORE series G550-09-06. �
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Form Revised OS/06/2014
° L� Mc�� l�lo�il� CERTIFICATE OF DESTRUCTION
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' �y �/�������"`�����% 2910 Hogum Bay Rd a�� �:
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E-Mail: lms@wcnx.org . �
Name: CO OP MUNICIPAL COURT-BREMERTON Phone: 1-877-898-0112 J� �~
Address: 550 PARK AVE Fax: 1-360-486-2467 °'l�.: �o`�
i BREMERTON 98337 �
C ty. , , .
Phone: 360-473-5242 Account#: 2185-952778-705 Route Id: SN92
Request: RWAUTO Invoice Date: 11/24/2015 Invoice #: 1188343
On the date shown, Designated Confidential Data was Shredded and Destroyed as per Customers Instructions.
Notes: Acct: 952778-705
Service Description ZQty Ra8t9 Amount
65SC 2.00 65 GAL SHRED CART
Driver Signature: �'U-�" _ Date: //-Z�-�� Truck
Customer Signature: Date: Time