HomeMy WebLinkAboutDispositions Forms_53-19_10/2/2019_FireRevised: 1/22/14
1. AGENCY IPARTMtENT
Village of Tequesta -A
PAGE % OF PAGES
3. BUREAU
N/A
4. ADDRESS (Street, City, and Zip Code)
5. CONTACT (Name and Telephone Number)
345 Tequesta Drive
Lori McWilliams; MMC
Tequesta, FL 33468
561-768-0440
6. SUBMITTED BY: I hereby certify that the records to be disposed of are
T. 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 B are to be disposed of in the
litigation pending or imminent.
manner checked below (specify only one):
Only the Department Head has the authority to sign off on Rem 6.
Signature Date
Name
Title
S. LIST OF RECORD SERIES
t.
schedule
b.
rom
C. d. e.
Title Retention Inclusive
Jr.
volume
9-
Disposition
Dates
in
Action and Date
ream
Cubic
Completed After
Felt
Authoricetion
C,5
9. DISPOSAL AUTHORIZATION: Disposal for the above listed records
authorized. Any deletions or modifications are indicated
Signature Date
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 Date
Print Name: Lori McWilliams, IAMC
Print Name
Print Title: village Clerk
Print Title
NOTE: Upon disposition retain this form for your records
Light gray shading indicates a field required to be completed by department.
Light blue requires a signature
Print Form
a
Revised : 1/22/14 PaGE of PACES
1.AGENCY 2 DEPARTMENT 3.BUREAU
Village of Tequesta , r C (LV S Ir" N/A
4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number)
345 Tequesta Drive Lori McWilliams; MMC
Tequesta, FL 33469 561-768-0440
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 B are to be dispos.0of in the
litigation pending or imminent manner checked below (specify only one):
Only the Department HaLd has the authority to sign off a'j It.:m E.
Signature Date
Name
Title
8. LIST OF RECORD SERIES
d. e.
Schedule Bern Title Retention Inclusive Volume Disposition
Item iYD Dates in Action and Dabs Cubic CompWtVd After
Fee Authorization
C- -A Li
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)
Signature Date Signature I ' 1"�— Date lg
Print Name: Lori McWilliams, IAMC Print Name
Print Title: Village Clerk Print Title
NOTE: Upon disposition retain this form for your records
Print Form
A
Revised : 1/22/14
i.AGENCY j 2.DEPARTMEN
Village of: Ti egUesta �— ; r c
PAGE OF PACES
3.BUREAU
N/A I
4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number)
345 Tequesta Drive Lori McWilliams, MMC
Tegrlesta, FL 33469 561-768-0440
6. SUBMITTED BY: I hereby certify that the records to be disposed of are T. NOTICE OF INTENTION
correctly represented below, that any audit requirements for the records
have been fully justified, and that further retention its not required for any The scheduled records listed in ItLnn o8 are to be disposed of in the
litigation pending or imminent. manner checked below (specify IY ):
Only the De-parfmenf Haad has the authority to sign cif on Ham 6.
Signature Date
Name
Title
a.
Schedule
item
8. LIST OF RECORD SERIES
b. C. d. e. f. 9-
rMm Title Retention Inclusive Yolumoe Disposition
in Adtion and Data
NO. Cubic
Gubic Completed Alter
Feat Au horiEstion
�, ►z r� rs
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)
Signature Date Signature ' ' IU r Date tfDb,/i
Print Name: Lori McWilliams, IdMC
Print Title: village Clerk
Print Name
Print Title
NOTE: Upon disposition retain this form for your rewords
_fight gray shading indicates a field required to be completed by department.
_ight blue requires a signature
Print Form
am