CERTIFICATE OF RECORDS DESTRUCTION

2. Date*
   Date
3. Your Name*
4. Department Name or Division*
   -- Select One --AccountingAdministrative ServBldg-InspecCIP-Const PlanningCommunicationsCustomer RelationsEconomic DevelopmentEngineering ServEnvironmental ServFacilities MgmtFinancial ServFire-EMS ServHuman ResourcesInformation TechLegislative ServLibrary ServMunicipal CourtParks-Rec ServPlanning ServPolice ServPublic WorksTown ManagerTreasury Operations
6. Are/Were the records eligible for destruction in accordance with the Town's Retention Schedule (Texas State Library & Archives Commission-TSLAC)?*

   1. Yes
   2. No
   3. Not sure

   If no or not sure, contact the Records Mgmt Coor/Deputy Town Secretary or review the Retention Schedule.
7. TSLAC
   Retention Schedule
9. Have the records already been destroyed?*

   1. Yes
   2. No
10. If yes, by what method?
    -- Select One --Electronically deletedShreddedTrashRecycledOther
11. If other method, describe:
13. 1ST ENTRY
15. Records Series Title*
    This is the title of the records as defined by TSLAC
16. Records Series Number
    This is the Record Number as defined by TSLAC (i.e. GR1000-3d)
17. Records Description*
18. Date/date range of records?*
20. 2ND ENTRY
22. Title
23. Series Number
24. Description
25. Date/Date Range
27. 3RD ENTRY
29. Title
30. Series Number
31. Description
32. Date/Date Range
34. 4TH ENTRY
36. Title
37. Series
38. Description
39. Date/Date Range
41. 5TH ENTRY
43. Title
44. Series
45. Description
46. Date/Date Range
48. 6TH ENTRY
50. Title
51. Series
52. Description
53. Date/Date Range
55. Who authorized the destruction of the records?*
    Name of supervisor or dept. head that authorized the destruction of records.
57. Do you have space limitations where you are unable to store the records until the Town-wide destruction day?*

    1. Yes
    2. No
    3. Not Applicable
58. If no, where are the records located?
    This information would be used to generate a facilities request to have the records transferred to records storage.
Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field