This form is for the destruction of public records in accordance with Administrative Procedure 185 – Records Management and Appendix B – Records Retention Schedule.
| School/Site/Department: | Inventoried by: |
| Record Series # |
Record Series Title | General Description | Open Date YYYY/MM |
Close Date YYYY/MM |
Retention | Notes – Division Office only |
DESTRUCTION APPROVALS: We certify that the records listed above have been retained for the scheduled retention period, required review has been completed, no pending or ongoing litigation or investigation involving these records is known to exist, and no misplaced records were included.
1. School/Department Approval
| Administrator/Department Supervisor: | ||
| Print Name | Signature | Date |
2. Send form to Division Office – Finance Department
| FOIP Coordinator Approval: | ||
| Print Name | Signature | Date |
3. Return form to School/Department
| Records Destroyed by: | ||
| Print Name | Signature | Date |
4. Return form to Division Office – Finance Department for permanent retention by FOIP Coordinator