HomeMy WebLinkAboutDispositions Forms_03-09_02/24/2009_Clerk6~EC®F~®~ ®9SP®SITI®~9 ®®ClJi~lEli9T NO~ ,~ - C `
Revised 11/9107 PAGE of 1 PAGES
'@. AGENCY 2. DEPARTMENT 3. BUREAU
i/illage of Tequesta f~/A
4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number)
345 Tequesta Drive Lori McWilliams, CMC
Tequesta, FL 33469 561-575-6200 ext. 244
6. SUBMITTED BY: I hereby certify that the records to be disposed of are 7. NOTICE OF INTENTION
correctly represented below, that any audit requirements for the records
have been fully justified, and that further retention is not required for any The scheduled records listed in Item 8 are to be disposed of in the
litigation pending or imminent. manner checked below (specify only one):
Signature ~/~
~ Date ~~1 ~
!
`
~ ~a. Destruction ~ b Microfilming and Destruction
~.~
/
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v O a 1 Shred ~ a.2 Recycle
0 c. Imaging and Destruction
Name and Title ~ d. Other
8. LIST OF RECORD SERIES
a. b. (~ \I 1 I`tt (rl~' c. ~ cl`1C~.Y k`~ ~.~ _
` d. e. f. g.
Schedule Item Title ~ Retention Inclusive Volume Disposition
Item No. t .{ ~ ~
' ' k ~' ~ ~ ~ 1 ~"'
'" Dates in Action and Date
~ Cubic Completed After
~_ { L ~ ~ ~ ~ ~~ ~~_ ~.~ Feet Authorization
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9. DISPOSAL AUTHORIZATION: Disposal for the above listed records
authorized. Any deletions or modifications are indicated
~. ~.. 10. DISPOSAL CERTIFICATE The above listed records have been
disposed of in the manner and on the date shown in column g.
(Witness to the Records Disposition)
Signature: ~ (~ ~ ~ ~ /r , y,_ Date: ~ ~~ y ~ ~
~ l l~L Signature: ~ Date ~ ,~{{
~ ~~ "6/
Print Name: Lori McWilliams Print Name:
Print Title: Village Clerk Print Title:
NOTE: Upon disposition retain this form for your records