HomeMy WebLinkAboutDispositions Forms_53-19_10/2/2019_Storage UnitRevised 11/9/07
RECORDS MSPOSMON DOCUMENT
NO. ,r .
PAGE I OF PAGES
I.AGENCY
2. DEPARTMENT
3. BUREAU
Village of Tequesta
NSA
4. 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
fi. 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
litigati imminent.
The scheduled records listed in Item 8 are to be disposed of in the
pending or
/O
manner checked below (specify only one):
a. Destruction b. Microfilming and Destruction
Signature Date
O a.1 Shred o a.2 Recycle
0 c. Imaging and Destruction
O d. Other
Name and Title
8, LIST OF RECORD SERIES
a.
Schedule
Item
b.
Item
i No.
c.
Title
i
d.
Retention
e.
Inclusive
Dates
f.
Volume
in
Cubic
Feet
g.
Disposition
Action and Date
Completed After
Authorization
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1. DISPOSAL AUTHORIZATION: Disposal for the above listed records
uthorized. 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: c Date:
OZ
'rint Name: Lori McWilliams
Print Name:
'rint Title: Village Clerk
Print Title:
NOTE: Upon disposition retain this form for Your records