HomeMy WebLinkAboutMUNICIPAL COURT 11/28/2017City 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)).
*Examples of methods of destruction: electronic deletion, in-house urs oursiae conrracror sruruuu,y, DCLUIC 1rLyu111y, vu— 1---,
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:
Employee Signature: "J )�.l�l_N] �j/ LtataA Nrinted Name: l� l�l_3Yl J1 ! QYYis Division: Y�Li_I')
The Records Manager must sign the approval of this quest prior to the destruction of the listed records:
Records Manager Signature: Printed Name: h" KM b", CO rt O— Date Approved:
The person/people responsible for the destruction of records must sign upon destruction of the listed records: �1 G
Employee Signature: JI �Printed Name: i 21 A..) n LA i' I aims Date Records Destroyed:
Vendor Business Name (if
Form Revised 05/06/2014
Phone:
frorri,Records Retention Schedule]
Agency Records
Legal Disposition Authority (taken
-
a °p _
t - „.
��
'
— D Date;Vlethod of
escuption -
a ;, Records Series
Re ords5enes Title ' "+
c
Records Retention._. ,
Mmimum,Retention�Penod.
.(Bok,!tem numbers, Dates covered m o Destruction (See
6n
r Re�ten ti
Schedule mss, ;
Yolur►ie;etc.) .Met' _examples�tielow*�=
Source Records —
GS50-09-14
CORE 3.3
Verification of Successful
DM52-0613-01
Closed October 24 —November
11-22-17
Secure shred bin
Images (Non-
Rev. 3
Conversion
22, 2017
for outside
Archival)
contractor
shredding
Source Records—
GS50=09-14
CORE 3.3
Verification of Successful
DM52-0613-01
Various Open Infractions 2007 -
11-22-17
Secure shred bin
Images (Non-
Rev. 3
Conversion
2017
for outside
Archival)
contractor
shredding
Uniform Notice of
DM52-0613-
District &
3 years
Closed October 1— 31, 2014
11-01-17
Electronic Copy
Infraction, Court
01
Municipal Courts
Deleted
Docket, & Case File
Retention
(infraction)
Schedule—V6
*Examples of methods of destruction: electronic deletion, in-house urs oursiae conrracror sruruuu,y, DCLUIC 1rLyu111y, vu— 1---,
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:
Employee Signature: "J )�.l�l_N] �j/ LtataA Nrinted Name: l� l�l_3Yl J1 ! QYYis Division: Y�Li_I')
The Records Manager must sign the approval of this quest prior to the destruction of the listed records:
Records Manager Signature: Printed Name: h" KM b", CO rt O— Date Approved:
The person/people responsible for the destruction of records must sign upon destruction of the listed records: �1 G
Employee Signature: JI �Printed Name: i 21 A..) n LA i' I aims Date Records Destroyed:
Vendor Business Name (if
Form Revised 05/06/2014
Phone:
I& A A MAG; j(- CERTIFICATE OF DESTRUCTION
j� 2910 Hogum Bay Rd
j�%r�'%///�%% Olympia Wa 98516
%i 51i// / //� E -Mail: Ims@wcnx.org
/////%/////////////%//%%G%%/%�%l%%//%%%///////%/ Phone: 1-877-898-0112
Name: CO OP MUNICIPAL COURT-BREMERTON Fax: 1-360-486-2467
Address: 550 PARK AVE
City: BREMERTON 98337
Phone: 360-473-5242 Account: 2185-952778-705 Route Id: SN92
Request: RWAUTO Invoice Date: 11/28/2017 Invoice #: 1304083
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:
Date:
Date:
Truck
Time