HomeMy WebLinkAboutDispositions Forms_36-19_8/27/2019_UtilitiesForm Updated: 1/3/17
No. 3& -1 `3
RECORDS DISPOSITION DOCUMENT
PAGE 1 OF 1 PAGES
1. AGENCY NAME
2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA
Number)
Lori McWilliams, MMC
DEPARTMENT: Utilities - Production
(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).
0 a. Shred Q b. Imaging and Destruction (�) c. Recycle
0 d. Removed from Server 0e. 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.
IaL (Akii ULL PLI� S.LaIL11 i��IeA6102L s - ao
Sig ature Name and Title (Seni r Staff only) bate
5. LIST OF RECORD SERIES
6.
a.
Schedule
b.
Item
C.
Title
d.
Retention
e.
Inclusive
f.
Volume
g.
Disposition
No.
No.
Dates
in
Cubic
Action and
Date
Feet
Completed
After
Authorization
GS 14
135
Utility Records: Reporting Compliance
5 yrs.
2007 - 2013
1
Monthly Operation Reports
3a l
TOTAL CUBIC FEET THIS PAGE:
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 letions or modifications are indicated.
itness to the records disposition)
alul b6119
Signature Date
Custodian/Records Liaison Officer Date
Name and Title
Form Updated: 1/3/17