Records Request for Destruction
Non Records and/or Public Records
Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Records Description and Date Range
*
We hereby request permission to destroy non records/public records described above. The records retention period, as established by the Functional Records Retention and Deposition Schedule, has expired and are to be destroyed immediately.
Number of Boxes
*
Department
*
By Submitting this form, I acknowledge that I have officially signed and authorized the information provided
*
yes
Submit
Should be Empty: