HomeMy WebLinkAboutDispositions Forms_35-19_8/27/2019_UtilitiesRECORDS DISPOSITION DOCUMENT
NO 3s—/9 5—/9
PAGE 1 OF 1 PAGES
1. AGENCY NAME
2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA
Number)
Lori McWilliams, MMC
DEPARTMENT: Utilities - Pumping and Storage
(561) 768-0443
3. NOTICE OF INTENTION: The scheduled records listed in Item 5 are to be disposed of in the manner checked
below (specify only one).
Qa. Shred Q b. Imaging and Destruction Q c. Recycle
d. Removed from Server Qe. Other
4. SUBMITTED BY:
I hereby certify that the records to be disposed of are 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.
pl�Z� �(� "VvLeAnn
SigAature Name and Title (Senior Staff only) Date
5. LIST OF RECORD SERIES
6.
a.
Schedule
No.
b.
Item
No.
C.
Title
d.
Retention
e.
Inclusive
Dates
f.
Volume
in
Cubic
g.
Disposition
Action and
Date
Feet
Completed
After
Authorization
GSI-SL
340
Disbursement Records - Detail
�ecq cl ge
Purchase Orders & requests
5 FY
4/22/2010-8/21/13
1
g 30
TOTAL CUBIC FEET THIS PAGE:
1
7. DISPOSAL AUTHORIZATION: Disposal for
8. DISPOSAL CERTIFICATE: The above and below listed records have
the above listed records is authorized. Any
been disposed of in the manner and on the date shown in column g.
d l'tionsor modifications are indicated.
(Witness to the records disposition)
gl jo)) q
Signature Date
W e d l t ��rr�� 1aiK�sfti�f,v� �Sis CA1
Custodian/Records Liaison Officer Date
,
Name and Title
Form Updated: 1/3/17