Fillable Certificate of Destruction (Louisiana Tech University)

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Certificate of Destruction (Louisiana Tech University)

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File type: PDF

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Certificate of Destruction
SSARC 933 (R 11/2010)
Once completed, keep this form with the corresponding approved
Authority to Dispose of Records form (SS ARC 930)
1. Name and Address of Agency
SECRETARY OF STATE
DIVISION OF ARCHIVES
RECORDS MANAGEMENT & HISTORY
P.O. BOX 94125, Capitol Station
Baton Rouge, Louisiana 70804-9125
2. Records Officer and Title
3. Certification of Destruction Statement
I hereby certify that the following records listed below were disposed of by:
Landfill Recycling Shredding Incineration Maceration Pulverization Degaussing
Other:
on for the Agency listed in section one above.
Witness (Signature) Witness Name (Printed)
Listing of Records Being Destroyed
Records Series Inclusive Dates or File Break
Print Form
Nolan Eller, University Archivist/ Records Officer
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Certificate of Destruction (Louisiana Tech University)

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Completed 22 August 2020

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