HomeMy WebLinkAboutDispositions Forms_05-09_02/24/2009_ClerkFtEC®R®S ®ISP®SI~I®IV ®®CflJI~iEN~' No. ~ - 0 9 r
Revised 11/9/07 PAGE OF 1 PAGES
'V. AGENCY 2. DEPARTMENT 3. BUREAU
Village of Tequesta NSA
6. 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: 1 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
litigation pending or imminent The scheduled records listed in Item 8 are to be disposed of in the
. manner checked below (specify only one):
Signature ' Dat
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~a Destruction ~ b. Microfilming and Destruction
-
C.:' c
a.1 Shred ~ a.2 Recycle
c. Imaging and Destruction
Name and Title ~ d. Other
8. LIST OF RECORD SERIES
a.
Schedule
Item b.
Item
Ivo. 1-l j 1 I ~+v m s c.
Title
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1 ~~\(„~ ~cl - ~ ~ ~~. ~ ~ ~ : ,_ t d.
Retention e.
Inclusive
Dates f.
Volume
in g.
Disposition
Action and Date
`
r\~'`'" ~+~'~'~~ t ~ ~~--'~"l' Cubic
Feet Completed After
Authorization
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9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have been
authorized. Any deletions or modifications are indicated disposed of in the manner and on the date shown in column g.
(Witness to the Records Disposition)
1 ~
Si nature. n ; '
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g = ~~~~~ ~ ~ Il,~l~_' '-yam Date: ~ J ~ .'
Signature:,r..,
~~ r Date:
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Print Name: Lori McWilliams Print Name:
Print Title: Village Clerk Print Title:
NOTE: l.1DOn disposition retain this form for vour records