HomeMy WebLinkAboutMUNICIPAL COURT 08/22/2017City 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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GS50-09714
CORE 3 3 -
Verification"of Successful
DM52-06B-01
Closed July 22 -August 18,
08-18-17
Secure shred bin
Images (Non=,
Archival)
Rev: 3
Conversion, ' °
2017
for outside
contractor
shredding
Uniform Notice of
DM52=0667
District 8
3 years
Closed July 1- July 31, 2014
08-01-17
Electronic Copy
Infraction', Court
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Deleted
-Docket, & Case File
Retention
(infraction)
Schedule'- V6
*Examples of methods 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 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: /� 1
Employee Signature: ') 1'7 WdLainA Printed Name:I)a
1 1 ) n—f t 1 I I I C. 0_ S Division: A-) I C:.t�JC
The Records Manager must sign theavproval of this request prior.to the destruction of th isted records:
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Records Manager Signature: Printed Name: Date Approved: 2,2 - ( 7
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
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Employee Signature:i A 5 n O ,1/� OJ006 Printed Name: DQ.I 3n w I I 10_1--n s Date Records Destroyed:
Vendor Business Name (if used):
Vendor Signature:
Form Revised 05/06/2014
Pho
Printed
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.
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CERTIFICATE OF DESTRUCTION
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Name: CO OP MUNICIPAL COURT-BREMERTON
Address: 550 PARK AVE
City: BREMERTON 198337
2910 Hogum Bay Rd
Olympia Wa 98516
E -Mail: Ims@wcnx.org
Phone: 1-877-898-0112
Fax: 1-360-486-2467
Phone: 360-473-5242 Account: 2185-952778-705 Route Id: SN92
Request: RWAUTO Invoice Dater 8/22/2017 Invoice #: 1288685
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 3.13
SHEXB 1.00 SHRED EXTRA BOX
3..47
Driver Signature
Customer Signature:
l Date: Truck
Date:
Time