Library Archive Destruction Certification Form
Complete this form to document and certify the destruction of library archive materials. All information provided will be used for official certification and recordkeeping.
Material Title
*
Material Type
*
Please Select
Book
Manuscript
Periodical
Microfilm
Photograph
Digital Media
Other
Reference or Accession Number
*
Description of Materials
*
Date of Destruction
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Destruction Method
*
Please Select
Shredding
Pulverizing
Incineration
Digital Deletion
Other
Reason for Destruction
*
Please Select
Obsolete Content
Damaged Beyond Repair
Duplicate Copy
Retention Period Expired
Other
Authorized By (Full Name)
*
First Name
Last Name
Position/Title of Authorizer
*
Certification and Attestation Signature
*
Submit Certification
Submit Certification
Should be Empty: