Records Request for Destruction
Non Records and/or Public Records
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Records Description and Date Range (please be specific)
*
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.
Physical records: Number of Boxes (if not applicable, type in "None")
*
Electronic records: Number of Documents (if not applicable, type in "None")
*
Department
*
By Submitting this form, I acknowledge that I have officially signed and authorized the information provided
*
yes
Submit
Should be Empty: