HomeMy WebLinkAboutMUNI COURT - 06/28/2016 ,� 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(COREJ).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
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 MeY��n examples below•)
Source Records— GS50-09-14 CORE 3.1 Verification of Successful DM52-06B-01 Closed May 24,2016—June 22, 06-22-16 Secure shred bin
Images(Non- Rev. 1 Conversion 2016 for outside
Archival) contractor
shredding
Uniform Notice of DM52-06B- District& 3 years Closed May 1—May 31, 2013 06-01-16 Electronic Copy
Infraction, Court 01 Municipal Courts Deleted
Docket,&Case File Retention
Schedule—V6
Uniform Citation, DM52-06A- District& 3 years Closed April 1-30, 2013 OS-01-16 Secure shred bin
Complaint,Court 01 Municipal Courts for outside
Docket&Case File Retention contractor
Schedule—V6 shredding
Uniform Citation, DM52-06J-01 District& 3 years Closed October 1,2012—April 05-01-16 Secure shred bin
Complaint,Court Municipal Courts 30, 2013 for outside
Docket&Case File Retention contractor
(parking) Schedule—V6 shredding
*Examples of inerhods 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 reasonab/y anticipated litigation or
public records reguests,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: � 1-1 ��[ �� Printed Name: � 1 1 ���S�n Division: 1 ' +Un�Ci�-�a.� t=n� �1�'�'
The Records Manager must sign he approv �this request pr�or to the destruction of the listed records:
�
� � �'� �•�3-/�
Records Manager Signature: � Printed Name �iL�--� �� �` r� � Date Approved: �
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: � Printed Name: � .!_5� I v t'/1 �J�n �ate Records Destroyed: (O � a�— I �
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 Destrudion Log is"Retain for the life of the agency'pursuant to COREseries G550-09-06.
Form Revised OS/06/2014
' LG� �A41 MO�IIC�i CERTIFICATE OF DESTRUCTION
� ��� �'//i, 'f%i. % �/ a FOR INE'p �
' �,��,, ����/�/��������� ����/�� 2910 Hogum Bay Rd ,��� �o�
��`���� �� �� �����'�,�/ OI m ia Wa 98516
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E-Mail: lms@wcnx.org � . �
Name: CO OP MUNICIPAL COURT-BREMERTON Phone: 1-877-898-0112 �~
Address: 550 PARKAVE Fax: 1-360-486-2467 °%�yN. �ao��c
Cit . BREMERTON , 98337 �
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Phone: 360-473-5242 Account#: 2185-952778-705 Route Id: SN92
Request: RWAUTO Invoice Date: 6/28/2016 Invoice#: 1221819
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 EXTRA BOX 3.26
Driver Signature: Date: Truck
Customer Signature: Date: Time