Indiana Supreme Court Division of State Court Administration DESTRUCTION CERTIFICATION FORM-IMAGING Send this form to the Division of State Court Administration, 30 S. Meridian St., Suite 500, Indianapolis, IN 46204, upon scanning a record series but before destruction of these records occurs. The following court records have been scanned in accordance with imaging standards of Administrative Rule 6 pursuant to the specific retention schedule found in Administrative Rule 7: [Cite the dates of records being scanned and provide the appropriate retention schedule.] Use one form per record series _________________________________________________________________ _________________________________________________________________ I certify that each of the documentation, legibility and permanency standards set forth in Administrative Rule 6 (H) (1), (2) and (3) have been met and have been documented as part of the appropriate documentation file: 1) The records listed above have been approved for scanning by the appropriate court. 2) The Clerk maintains a permanent General Documentation file on these records as required under Administrative Rule 6. 3) The Clerk maintains a permanent Specific Documentation file as required under Administrative Rule 6, in which the following steps have been approved, documented and audited for compliance: (a) a specific weeding policy was implemented for these records and said policy has been retained as part of the documentation file: (b) the images have been verified against the originals, by a document-by-document inspection; (c) the images have been scanned at no less than 300 dpi. (d) The digital master incorporates the file format, TIFF Group 4, meeting ISO standard 12639:2004, is stored in an environment meeting ANSI/AIIM TR25-1995, and is monitored for deterioration on a regular basis in accordance with ANSI/AIIM MS59-1996. 4) Required documentation and quality control target, X441 or X443, in accordance with ANSI/AIIM MS44 (R1993), with original signature on each form has been used and as part of the documentation file. 5) The appropriate, authorized person has audited each of the above procedures and finds that the production is in compliance with each and every requirement of Administrative Rule 6. 6) Permanent court files, CCS, and RJO records shall be converted to microfilm in accordance with Administrative Rule 6 (G). ________________________________ [Seal] Clerk of the Circuit Court ________________________________ date TCM-AR6(K)-2 Revised by Division of State Court Administration 1/12 American LegalNet, Inc. www.FormsWorkFlow.com