CERTIFICATE OF RECORDS DESTRUCTION
(Form RM-3 July 2008)
Archival and Records Management Services Division
800 E. Broad St., Richmond VA 23219
(804) 692-3600
This form documents the destruction of public records in accordance with the Virginia Public Records Act, § 42.1-76 through 42.1-91 of the Code of Virginia.
1. Agency / Locality
2. Division / Department / Section
3. Person Completing Form
4. Address
5. Telephone Number & Extension
6. Records to Be Destroyed
a) Schedule and Records
Series Number
b) Records Series Title c) Date Range (mo/yr) d) Location e) Volume
f) Destruction
Method
DESTRUCTION APPROVALS
NOTE: Public records may not be destroyed without receiving prior approval from your agency or locality Records Officer.
We certify that the records listed above 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.
7. Approving
Official (Print) Signature
Date
8. Designated Records
Officer (Print) Signature Date
9. Records
Destroyed By (Print)
Signature Date
