HomeMy WebLinkAboutMUNI COURT - 05/31/2016 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
Descrlptfon Date Method of
Records Serles Title Records Series Records Retention Mlnimum Retentlon Perfod (Box/Item numbers, Dates Cove�ed Minimum Destrudion(See
DAN Schedule volume,etc.) Ret11ennYlon examples below•)
Source Records— GS50-09-14 CORE 3.1 Verification of Successful DM52-066-01 April 26—May 23,2016 05-23-16 Secure shred bin
Images(Non- Rev. 1 Conversion for outside
Archival) contractor
shredding
Uniform Notice of DM52-06B- District& 3 Years Closed April 1—30,2016 05-01-16 Electronic Copy
Infraction,Court 01 Municipal Courts Deleted
Docket&Case File Retention
Schedule—V6
*Examples of inethods of descruction: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 onqoing 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: _J Printed Name: ..L�C�C�.�V 1� �fZ � S�Y�I Division: �U 1n 7 C�.-l�Gl)/ ��U��
The Records Manager must sign the approval of this request prior t'b the destruction of the listed records:
Records Manager Signature: \��,�/L,p �� Printed Name:�/� rl:i�.L�.L.� � ' �-�J�l�/�Date Approved: �� ���/��
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: % �( l 1 Jl rYl _ rinted Name�1�C�i .1 .l�� vV�� Date Records Destroyed: �'�`-? � ` `�-✓
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 agency"pursuant to CORE series G550-09-06.
Form Revised 05/06/2014
��i M�� MO�II(�i CERTIFICATE OF DESTRUCTION
�� � � a�OR U�jc��
� ��2�,�� ���/ 2910 Ho um Ba Rd ~��
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E-Mail: lms@wcnx.org � • �
Name: CO OP MUNICIPAL COURT-BREMERTON Phone: 1-877-898-0112 � '��~
Address: 550 PARK AVE Fax: 1-360-486-2467 , °',�y��_, �o`�
Cit . BREMERTON , 98337 •!:.!:
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Phone: 360-473-5242 Account#: 2185-g52778-705 Route Id: SN92
Request: RWAUTO Invoice Date: 5/24/2016 Invoice #: 1216518
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 Z, 2.89
SHEXB 1.00 SHRED�XTRA BOX 3.26
Driver Signature: Date: Truck
Customer Signature: Date: Time