Unified Judicial System Schedules Court Records Disposal Certification Request

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNIFIED JUDICIAL SYSTEM SCHEDULED COURT RECORDS DISPOSAL CERTIFICATION REQUEST [Pursuant to PA RJA 507(b)]:::::::Index No.IF APPLICABLECOUNTYJUDICIAL DISTRICTMAGISTERIAL DISTRICTDISTRICT JUSTICE NAMECalendar No.OFFICE OF ORIGINPERSON MAKING DISPOSAL REQUEST (RECORD CUSTODIAN)JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)ADDRESSApproval Requested For:Records DestructionRecords Transfer to PHMCRECORD TITLE AND INCLUSIVE DATES (oneseriesperform)DESCRIPTION OF RECORD (includetypeofinformationcontainedandpurposeofrecord). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PAGE AND SECTION IN SCHEDULE RETENTION PERIOD IN SCHEDULEYesNoNot Applicable HAVE ALL AUDIT REQUIREMENTS BEEN MET?QUANTITYTHE PEOPLE OF THE STATE OF NEW YORK TOTOTAL CUBIC FEETNo. of cartonsLengthWidthHeightOF AVERAGE CARTONNo. of volumesLengthWidthHeightOF AVERAGE VOLUMELegalLetterOtherNo. of file drawersARCHIVAL MEDIUM UTILIZEDHAVE RECORDS BEEN MICROFILMED?YesNoSize:16mm35mmOtherForm:RollCartridgeCassetteFicheGREETINGS:OtherLOCATION OF SECURITY COPYWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,FOR USE BY RECORD CUSTODIANlocated at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomhereby requests that the Record Retention Officer seek approval from the Administrative Office of Pennsylvania Courts for permission to dispose of or transfer the records identified above.DateSignaturePhone NumberYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.FOR USE BY DISTRICT RECORDS RETENTION OFFICERAuthorization to dispose of or transfer the above-identified records is requested. If destruction of the records is requested, I certify that the records have been reproduced on a medium approved by the Administrative Office of Pennsylvania Courts.DateSignatureJudicial District, one of the Justices of theFOR USE BY THE ADMINISTRATIVE OFFICE OF PENNSYLVANIA COURTSCourt in Witness, Honorableday of, 20 County,Review by the Pennsylvania Historical and Museum Commissionrequested.is notisDateTitleSignature(Attorney must sign above and type name below)FOR USE BY THE PENNSYLVANIA HISTORICAL AND MUSEUM COMMISSION ONLY IF REVIEW REQUESTED BY AOPCConcur With RequestRecommend Denial of RequestRecommend Disposal Request Be Amended As Follows:Attorney(s) forDateTitleSignatureFOR USE BY THE ADMINISTRATIVE OFFICE OF PENNSYLVANIA COURTSOffice and P.O. AddressApproval is given for:Transfer to PHMC DisapprovedDestruction as AmendedDestructionRetain Pending Further Instructions Comments/Amendments:Telephone No.: Facsimile No.: E-Mail Address:TitleSignatureDateOriginal must be sent to the Administrative Office of Pennsylvania Courts, 1515 Market Street, Suite 1414, Philadelphia, PA 19102. Keep a copy for your records.Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com</document>