HomeMy WebLinkAboutMUNICIPAL COURT 6/20/2017City 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)).
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6550-09 14. CORE 3.3
Verification of Successful :
DM52-06B-01
Closed April 21— May 19, 2017
05-19-17
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City of Bremerton Public Records Destruction Log
Employee Signature: nry-1 Ian IA i (i Q I�Y�K Printed Name: i.1 I ' �Q l�(j„rncw Division:
The Records Manager must si . the approval of this request ®rior to the destruction of th listed records: �e�
Records Manager Signature: Printed Name: - W� � Date Approved: A
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: Printed Name: 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 Destruction Log is 'Retain for the life of the agency' pursuant to CORE series GS50-09-06.
Form Revised 05/06/2014
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CERTIFICATE OF DESTRUCTION
CO OP MUNICIPAL COURT-BREMERTON
550 PARK AVE
BREMERTON 98337
2910 Hogum Bay Rd
Olympia Wa 98516
E -Mail: Ims@wcnx.org
Phone: 1-877-898-0112
Fax: 1-360-486-2467
360-473-5242 Account #: 2185-952778-705 Route Id: SN92
RWAUTO Invoice Date: 5/23/2017 Invoice #: 1273823
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 L, 2.98
SHEXB 1.00 SHRED EXTRA BOX 3.36
Driver Signature: Xv y Date: Truck
Customer Signature: Date: Time