Form 185-1

Certificate of Destruction for Schools and Departments

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


Adopted October 2020