Form RM-1: RECORDS DESTRUCTION AUTHORIZATION FORM
The records listed below (or on the attached list) are scheduled to be destroyed, as indicated on the Records Retention Schedule.
The records are not the subject of any claim, litigation, investigation, or audit. (List records here, or attach a list)
File #
Records Description
From
(Start Date)
To
(End Date)
Box #
Retention #
Retention Period
Check one option for destruction:
Shredding is Required (Records contain private information) OR Recycle (Records do NOT contain private information)
_________________________________ ___________________________ Employee Preparing Form Date
DOCUMENTS HAVE BEEN REVIEWED AND APPROVED FOR DESTRUCTION _________________________________ ___________________________ Department Head / Division Manager Date
_________________________________ ___________________________ City Clerk Date
_________________________________ ___________________________ City Attorney Date
Return this form to the originating department following approval (they coordinate the shredder arrangements) --------------------------------------------------------------------------------------------------------------------------------------- (Complete after destruction has been performed, if done by City Employees. If destruction is performed by a commercial vendor, have them provide you with a certificate.) I HEREBY CERTIFY that the items listed above have been destroyed in accordance with City policies and procedures:
______________________________ ___________________________ Employee Performing Destruction Date
Return this form to the City Clerk’s Office after completion. ©1998-2022 Gladwell Governmental Services, Inc.
Date: _________ Department: _______________