Unified Judicial System Disposal Log For Non Permanent Records {AOPC 507B} | Pdf Fpdf Doc Docx | Pennsylvania

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Unified Judicial System Disposal Log For Non Permanent Records {AOPC 507B} | Pdf Fpdf Doc Docx | Pennsylvania

Unified Judicial System Disposal Log For Non Permanent Records {AOPC 507B}

This is a Pennsylvania form that can be used for Administrative Office within Statewide.

Alternate TextLast updated: 5/16/2016

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Page _____ of _____ Unified Judicial System Disposal Log ­ Non-Permanent Records 1. ____________________________________ County 2. __________________________________________ Judicial District 3. ________________________________________ Record Custodian 4. ____________________________________ Office/Department 5. __________________________________________ Address 6. _________________________________________ Telephone No. 7. 8. AUTHORIZATION FOR DISPOSAL SCHEDULE [§ Name (e.g. 5.7 Juvenile)] 9. 10. 11. MICROFILMED (Y-N) 12. RECORD TITLE INCLUSIVE DATES OF RECORDS FORMAT ORIGINAL (Y-N) FOR USE BY RECORD CUSTODIAN I, _____________________________________________, hereby request that the Record Retention Officer authorize the disposal of the listed records. Record Custodian's Name ______________________________________________ Record Custodian's Signature ___________________________________________ Title ____________________________________ Date FOR USE BY RECORD RETENTION OFFICER I, _____________________________________________, hereby approve of the disposal of the records listed as requested. Record Retention Officer's Name ______________________________________________ Record Retention Officer's Signature ___________________________________________ Title ____________________________________ Date Original to be retained by the District Record Retention Officer. Copy to be provided to the Record Custodian. Copy to be provided to the AOPC on or before January 15th each year. Send a copy to Administrative Office of PA Courts, 1515 Market Street, Suite 1414, Philadelphia, PA 19102. AOPC 507B American LegalNet, Inc. www.FormsWorkFlow.com

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