HomeMy WebLinkAboutMUNI COURT - 08/23/2016 �
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 destro�/' (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) Agenty Retords
Descrlption Date Method of
Records Series Records RetenUon Dates Covered Minlmum Destruction(See
Records Series Title DAN Schedule Minimum Retention Period (Box/Item numbers, Retention
volume,etc.) Met examples below•)
Source Records— GS50-09-14 CORE 3.1 Verification of Successful DM52-066-01 Closed July 22,2016—August 08-19-16 Secure shred bin
Images(Non- Rev. 1 Conversion 22,2016 for outside
Archival) contractor
shredding
Uniform Notice of DM52-06B- District& 3 years Closed July 1—July 31,2013 08-01-16 Electronic Copy
Infraction,Court 01 Municipal Courts • Deleted
Docket,&Case File Retention
Schedule—V6
Uniform Citation, DM52-06A- District& 3 years Closed May 1,2013—July 31, 08-01-16 Secure shred bin
Complaint,Court 01 Municipal Courts 2013 for outside
Docket&Case File Retention contractor
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 ongoinq or reasonably 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:
EmployeeSignature: _ Printed Name: .l 1 l�l'�l 'v ���� Division:_� VYl � ��L�.�L � CD U r�
The Records Manager must sign t e approval o this request prior to the destruction of the listed records:
Records Manager Signature: r�� Printed Name: !���, ���1�iN �,��( V � _Date Approved: U� ��'��
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature:�Q�I.�U�'Yl r Printed Name: �Ja�l..��1� 1 �.i�it S('�� Date Records Destroyed: �������
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 retenfion 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
- L� Me�� Mol�il� CERTIFICATE OF DESTRUCTION
, � f'f '�//i. �b �FOA INfQ m
• ��'���� '�i�����i 2910 Hogum Bay Rd , �p�� �:
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� ����'���� ������/��,� Olympia Wa 98516 0� �
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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 °�1��. �o.�
Cit : BREMERTON , 98337 �!9.!:
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Phone: 360-473-5242 Account#: 2185-g52778-705 Route Id: SN92
Request: RWAUTO Invoice Date: 8/23/2016 Invoice#: 1230574
On the date shown, Designated Confidential Data was Shredded and Destroyed as per Customers Instructions.
Notes:Acct: 952778-705
Service Description �Qty Ra�t6 Amount
65SC 2.00 65 GAL SHRED CART
SHEXB 1.00 SHRED EXTRA BOX 3.33
Driver Signature: Date: Truck
Customer Signature: Date: Time