4.2.2024 Certificate of Records Destruction

ARCHIVES AND RECORDS MANAGEMENT
of
Revised 08/2013
An Equal Opportunity Employer
As authorized under ARS §41-151.19, ...A report of records destruction that includes a list of all records disposed of shall be filed at least annually 
with the state library on a form prescribed by the state library.
Failure to comply with these procedures is a violation of ARS §41-151.19.
Public Body
City of El Mirage
Division
ARIZONA STATE
LIBRARY, ARCHIVES AND PUBLIC RECORDS
A DIVISION OF THE ARIZONA SECRETARY OF STATE
Joan Clark, State Librarian & Director
Page
CERTIFICATE OF RECORDS DESTRUCTION
# of Files, Boxes, 
Reels; Electronic 
File Size
Aztec Engineering Contract
GS 1023
10321
9.16.2014
3.16.2015
Paper
1
Department
City Clerk
Office/Unit
Record Series Title as Stated on Approved Schedule
Schedule Number 
or Date
Item #
Records Start 
Date
Records End 
Date
Format:
 Paper, Digital, 
Microfilm
1
Amanda Rosas Housing File
000.12.57
12
3.3.2004
3.3.2019
Paper
1
James Shano Employment Letter
GS 1018
10463
11.21.2017 3.30.2018
Paper
1
Paper
1
Shums Coda aAssociates Agreement
GS 1023
10321
4.2.2019
4.3.2019
Paper
1
Paper
1
Paper
1
Paper
1
Paper
Name (type or print):
Title: Records Officer or Designee (type or print):
Phone :
Wendy Henson
Deputy City Clerk
623.876.2931
1
Paper
RECORDS MANAGEMENT CENTER
1919 West Jefferson Street  •  Phoenix, Arizona  85009  •  Home Page:  http://www.azlibrary.gov/records
Phone:  (602) 926-3815  •  FAX:  (602) 256-2838  •  E-Mail:  records@azlibrary.gov
Signature:
E-Mail:
Date:
whenson@elmirageaz.gov
4.2.2024

ARIZONA STATE
LIBRARY, ARCHIVES AND PUBLIC RECORDS
A DIVISION OF THE ARIZONA SECRETARY OF STATE
Joan Clark, State Librarian & Director
ARCHIVES AND RECORDS MANAGEMENT
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Revised 08/2013
An Equal Opportunity Employer
INSTRUCTIONS
Use this form ONLY for records that were destroyed and were on a current approved Retention Schedule.
In the top section enter the name of your Agency or Public Body, and include any subdivision breakdown for division, department or unit.
If additional pages are needed for reporting, please save and print the form and fill in the corresponding page numbers at the top of the form.
At the bottom of the form enter the Agency or Public Body name, date on which the records were destroyed, and the printed and signed name 
of the individual who actually performed or arranged with a contracted vendor for the destruction of the records.
Mail or e-mail the original completed form to the Arizona State Library, Archives, and Public Records, Records Management Center.  Fax 
copies are acceptable only if the received fax is legible.
RECORDS MANAGEMENT CENTER
1919 West Jefferson Street  •  Phoenix, Arizona  85009  •  Home Page:  http://www.azlibrary.gov/records
Phone:  (602) 926-3815  •  FAX:  (602) 256-2838  •  E-Mail:  records@azlibrary.gov
List the Record Series titles associated with the destruction using the exact record series name(s) found on the approved Retention Schedule 
being following.
Enter either the schedule number or approved date for the Retention Schedule you are following to determine eligibility for destruction.
Enter the item number from the authorized schedule you are following.
Enter the earliest date of records you are requesting to destroy under the Records Start Date  column and the latest date for the records you are 
requesting to destroy under the Records End Date  column.
Enter the format of the records to be destroyed under the Format: Paper, Digital, Microfilm  column.
Enter the amount of records being destroyed under the Number of Files, Boxes, Reels or Electronic File Size  column.