HomeMy WebLinkAboutDispositions Forms_55-19_10/9/2019_Clerk NO. 55-19
RECORDS DISPOSITION DOCUMENT PAGE 1 OF 1 PAGES
1. AGENCY NAME and ADDRESS 2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA Number)
345 Tequesta Drive Lori McWilliams, MMC
Tequesta, FL 33469 (561) 768-0443
3. NOTICE OF INTENTION: The scheduled records listed in Item 5 are to be disposed of in the manner specified
below (specify only one).
I a. Shred at Department Level 0 c. Send to Storage until e. Recycle
Disposition Date Met
0 b. Send to Storage for Shredding d. Removed from Server (3 f. 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.
Lori McWilliams Digitallye:2019.1signed009by Lori1320McWilli13-04'a00'ms g
Villa e Clerk 10/09/10
Dat
Signature Name and Title (Senior Staff only) Date
5. LIST OF RECORD SERIES
a. b. c. d. e. f. g.
Schedule Item Title Retention Inclusive Volume Disposition
No. No. Dates in Action and
Cubic Date
Feet Completed
After
Authorization
GS1-SL 375 TRUTH IN MILEAGE (TRIM) COMPLIANCE 5 FY 2005/2006 - 2013/201. 1 Recycled
FILES y
Caft\ Oct 36 *02.431 S-Ma-H Mecordt a� 10/9/10
GS 3 l LI 3 Cand�da4et lb / irr. d►COrbta •
651-SL 19( ReLorcll t P°4"o" ac:›1city, �
TOTAL CUBIC FEET THIS PAGE:
6. DISPOSAL AUTHORIZATION: Disposal for 7. DISPOSAL CERTIFICATE: The above listed records have been
the above listed records is authorized. Any disposed of in the manner and on the date shown in column g.
deletions or modifications are indicated.
Lori McWilliams )1''712o;9;otlo9Y,3:Z2zo oos 10/09/10 Lori McWilliams oa9'aa1;9;o°o9Y,3°22'21woos Village Clerk 10/09/19
Records Liaison Officer Signature Date Signature Name/Title Date
Routing:
1. Originates with Department Senior Manager, then j 1. Originates with Department Senior Manager, then
2. Village Clerk's Office authorizes disposition, and returns to i 2. Village Clerk's Office authorizes disposition and/or storage
3. Originating department to dispose and document column at the storage room and the"Clerk's Office"will contact
"g" originating deaprtment then sends Public Works to take the records to storage
4. Completed form to Village Clerk's Office for permanent 3. Clerk's Office will be responsible for final disposition of
archival records at this point
Form Updated: 10/7/19