HomeMy WebLinkAboutMUNICIPAL COURT 09/29/2021 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(CORE)).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Description Date Method of
Records Series Title Records Series Records Retention Minimum Retention Period (Box/Item numbers, Dates Covered Minimum Destruction(See
DAN Schedule volume,etc.) Re Lion examples below*)
MeSource Records— GS50-09-14 CORE 4.0 Verification of Successful DM52-06A-01 Various Dates 9-24-21 Secure shred bin
Images(Non- Rev.3 Conversion for outside
Archival) contractor
(All Case Types) shredding
Uniform Notice of DM52-06B- District& 3 years Closed June 1— August 31, 9-01-21 Electronic Copy
Infraction,Court 01 Municipal Courts 2018 Deleted
Docket, &Case File Retention
(All Case Types) Schedule—V6
Uniform Notice of DM52-06A- District& 3 years Closed June 1— August 31, 9-01-21 Secure shred bin
Infraction,Court 01 Municipal Courts 2018 for outside
Docket,&Case File Retention contractor
(criminal) Schedule—V6 shredding
Uniform Notice of DM52-06B- District& 3 years Closed June 1— August 31, 9-01-21 Secure shred bin
Infraction,Court 01 Municipal Courts 2018 for outside
Docket, &Case File Retention contractor
(parking&photo) Schedule—V6 shredding
*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:
Employee Signature: ,�AJY1 7�t 1kr.cj Printed Name: ' )Y-1 W 1 I I 1 1,Y i'S Division: )'y') l,r) I cz 1 pO COI) r '
The Records Manager must sign the approval of this request prior to the destruction of the listed record�� �:
0 /
Records Manager Signature.jac,432,Aftt5\YPr\f Printed Name: ei 11 1 l,/ �� " Date Approved: 1 1
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Form Revised 05/06/2014
Name: CO OP MUNICIPAL COURT-BREMERTTIFRTIFICATE OF DESTRUCTION
Address: 550 PARK AVE coR IN,
City: BREMERTC 98337 Le Mai Mobile �o�, a
Phone: 360-473-5242 r4. � �/ p�� j/� /�/ i
Request: RWAUTO 3/4ij7 % ir%/r r./ i CE'BTIFIED E
Ao
VV /ZO0�0/0���i/"0.7/iA.�// %%�% %r'/ to 11111. r
Account : 2185-952778-705 Service Date: 9/28/2021 Route Id: SN92 Ticket#: . 1531577
On the date shown, Designated Confidential Data was Shredded and Destroyed as per Customers Instructions.
CUSTOMER COPY
Service Description ty Rate Amount
65SC 1.00 65 GAL SHRED CART 12.88
SHLXB 1.00 SHRED EXTRA BOX 3.57
4—
Driver Signature: CDate :} /fi
: C 6!)n/ Truck
Customer Signature: Date: Time fr:
2910 Hogum Bay Rd Olympia Wa 98516 E-Mail: Ims@wcnx.org Phone: 1-877-898-0112 Fax: 1-360-486-2467