Certificate of Records Destruction



Дата26.04.2016
Памер124 Kb.
#34069

Records Analysis Section

800 E. Broad St., Richmond VA 23219

(804) 692-3600




Certificate of Records Destruction

(Form RM-3 January 2013)




This form documents the destruction of public records in accordance with the Virginia Public Records Act, §§ 42.1-76 through 42.1-91 of the Code of Virginia.
SUBMIT FILLABLE FORM WITH ORIGINAL SIGNATURES


1. Agency / Locality / Regional Entity

2. Division / Department / Section

3. Person Completing Form

     

     

     

4. Address, City, St, & Zip

5a. Telephone Number & Extension

5b. E-mail Address

     

     

     




6. Records to Be Destroyed

a) Schedule and Records Series Number

b) Records Series Title

c) Date Range (mo/yr)

d) Location

e) Volume

f) Destruction Method

     

          

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


Destruction Approvals

NOTE: Public records may not be destroyed without receiving prior authorization from the agency or locality Approving Official and Designated Records Officer.

We certify that the records listed above have been retained for the scheduled retention period, required audits have been completed, and no pending or ongoing litigation or investigation involving these records is known to exist.




7. Approving

Official (Type)      

Signature


Date      




8. Designated Records

Officer (Type)      

Signature

Date      




9. Records Destruction

Affirmed By:      

Signature

Date      

(No attachments accepted with the original RM-3)


Поделитесь с Вашими друзьями:




База данных защищена авторским правом ©shkola.of.by 2022
звярнуцца да адміністрацыі

    Галоўная старонка