HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Housing & Homeless Services; 2023-03-23This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 2021
P a g e | 1
DATE: 3-10-2023
REQUESTING DEPARTMENT:HHS REQUESTER:LEAH SORENSEN
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPT. HEAD/DIVISION MANAGER DATE RECORDS MANAGEMENT DATE CITY ATTORNEY DATE
*If more spaces are needed
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:___________________________DATE:______________
CERTIFICATE OF DESTRUCTION?YES NO
BOX NO. RECORDS DESCRIPTION DATED RRS NO.
RRS
PERIOD
TAB BARCODE
(if applicable)
56
AFFORDABLE HOUSING FILES:
LEWIS, DERIK & MARIA; MAYER,
DYLAN AND KELLI; DENISON, LAURA
DENISE; LOWE, BETTY; DIMOND,
RICHARD & PAULINE; JAMES,
STEPHANIE; BLESSMAN, DAWN;
MEAD, DONNA; GALL, ERIC
2017 HS-035
Loan
payoff +
5 years
RECORDS DESTRUCTION AUTHORIZATION FORM
SEE ATTACHED
CORODATA 3/23/2023
x
DocuSign Envelope ID: 2881 FD8C-9A31-4D54-BDD7-4A52587BA6A4
DATE: 3-10-2023 -------------
REQUESTING DEPARTMENT: HHS REQUESTER: LEAH SORENSEN
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
~ ~ 3/10/2023 3/20/2023
DEPT. HEAD/DIVISION MANAGER DATE RECORDS MANAGEMENT DATE CITY ATTORNEY
, click in the last bax in right hand earner af table and hit "tab". This will create mare fields in the table.
{'"city of
Carlsbad
□ □
3/20/2023
DATE
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 2021
P a g e | 2
TAB BARCODES DELETED BY:_____ _______________________________ DATE:______________MARIA EMERY 3/23/2023
DocuSign Envelope ID: 2881 FD8C-9A31-4D54-BDD7-4A52587BA6A4
I
C ciryof
Carlsbad
I
RECORDS DESTRUCTION REPORT
Maria Emery
DATE: 3/21/2023
TEMPLATE NAME: Physical Folder
TOTAL RECORD COUNT: 9
COMMENTS:
ENTRY ID REVIEW DATE NAME FILE NUMBER
4356221 03/21/2023 BLESSMAN, DAWN; 2688 ALAMEDA CIRCLE;
AFFORDABLE HOUSING
056050
4355889 03/21/2023 DENISON, LAURA DENISE; 4026 SAND COVE
WAY; AFFORDABLE HOUSING
056050
4354611 03/21/2023 DIMOND, RICHARD L. & PAULINE; 519
CHINQUAPIN AVE.; AFFORDABLE HOUSING
056050
4355177 03/21/2023 GALL, ERIC; 7024 FORSTERS TERN DRIVE;
AFFORDABLE HOUSING
056050
4355022 03/21/2023 JAMES, STEPHANIE; 7022 FORSTERS TERN;
AFFORDABLE HOUSING
056050
4354631 03/21/2023 LEWIS, DEREK & MARIA; 6008 PASEO
SALINERO; AFFORDABLE HOUSING
056050
4356928 03/21/2023 LOWE, BETTY; 5127 DON MIGUEL;
AFFORDABLE HOUSING
056050
4355541 03/21/2023 MAYER, DYLAN AND KELLI; 2681 ALAMEDA
CIRCLE; AFFORDABLE HOUSING
056050
4355935 03/21/2023 MEAD, DONNA; 2643 HANCOCK CIRCLE;
AFFORDABLE HOUSING
056050
0
d
Ca li fornia
Account #(s)SD012455
Certificate #102247
Date Issued Friday, March 24, 2023
Service Locations 5815 EL CAMINO REAL
Date Range of Service Mar-23-2023 thru Mar-23-2023
Work Ticket(s)1109694
Quantity/Item 40 -40 Boxes for Destruction (standard)
* Nothing in this certificate shall be deemed to modify the terms of the parties’ Service Agreement(s) or Work Ticket(s).
CERTIFICATE OF DESTRUCTION & RECYCLING
This Certificate is presented to: CITY OF CARLSBAD - RECORDS MANAGEMENT DIVISION
Per the express request of Client, Corodata has received the Material referred to below and has/will destroy and then
recycle said Material in accordance with its standard procedures. As the parties have agreed, Corodata will not
inventory, record or track any information contained within or related to the Material.
E•Jcorodata -tl HIPA'A
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