Destruction Certification Form

Indiana Supreme Court Division of State Court Administration DESTRUCTION CERTIFICATION FORM-MICROFILM

Send this form to the Division of State Court Administration, 30 S. Meridian St., Suite 500, Indianapolis, IN 46204, at the end of microfilming a records series but before destruction of records occurs.

The following court records have been microfilmed in accordance with microfilming standards of Administrative Rule 6 pursuant to the appropriate retention schedule found in Administrative Rule 7:

Use one form per record series

These original records appear on microfilm reels:

I certify that each of the seven elements have been met and are part of the appropriate documentation file:

1) The records listed above have been approved for microfilming by the appropriate court.

2) The Clerk maintains a permanent General Documentation file on these records as required under Administrative Rule 6 (G) (1).

3) The Clerk maintains a permanent Specific Documentation file as required under Administrative Rule 6 (G) (1), in which the following steps have been approved, documented and audited for compliance:

(a) a specific weeding policy was implemented for these records;

(b) the microfilm has been verified against the originals, in a frame-by-frame inspection;

(c) the records were microfilmed after the time frame established in Administrative Rule 7;

(d) all written exceptions authorizing the microfilm are on file.

(e) The microform meets the legibility requirements of Administrative Rule 6 (G) (2) (b), regarding resolution and (c) density and that test results are a part of the Specific Documentation file.

4) Required documentation and quality control targets, with original signature on each form have been used and are a part of the documentation file.

5) The original camera negative will not be used as a reference copy.

6) The original camera negative is stored in an environment specified in Administrative Rule 6 (G) (3).

7) The appropriate, authorized person has audited each of the above procedures and finds that the microfilm production is in compliance with each and every requirement of Administrative Rule 6.

TCM-AR6(K)-1 Revised by Division of State Court Administration 01/12