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HomeMy WebLinkAboutDispositions Forms_01-18_10/2/2019_FireRevised: 1/22/14 1. ACEI-t' 2. DEPARTMENT Village of Tegipesta . bi -1 k PAGE _0 p� PAGES &. BUREAU N/A 4. ADDRESS (Street, City, and Zip Code) 345 Teguesta Drive Tequesta, FL 33469 Name and Telephone Number) CONTACT 5. ( Lori McWilliams-, MMC 561-768-0440 6. 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. Only the Department Head has the fiuthrrity to sign oft al Italm 6. T. NOTICE OF INTEMT" The scheduled records listed in Item If are to be dispesged of in t#v_1 mariner checked below (sFech''f Only one): Signature Date Maine f Q� Title_ 8. LIST OF RECORD SERIES a. b. C. d. e. Schedule ltem Title Retention tnclusive Yaturr Dimes tiara Sc hed Dates In Aiftion " Diite Ct bic Completed After Feet AuthorVation �.�i V If �' V o o g 5 C'a51-S 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 mariner and on the date shown in column g. (XVitness to the Records Disposition) Signature � rn �` Date I a3 ' Signature Date AM — print game: Lori McWilliams, IAJAC Print Title: Village Clerk Print Name Print Title NOTE: Upon disposition retain this form for your records ght gray shading indicates a field requi Light blue requires a signature to be compieie y department. Print Form 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. SUBMn7ED 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 a are to be disposed of in the litigation pending or imminent manner checked below (spectlY OnIY One): Only Ong Dap- n))1-i sifp sign o!f co Itarz �. S ('cam I Signature to ' Marne Title 8. LIST OF RECORD SERIES 2. b. C. d. e. f, g- schedule Stem 'rrOa Retention Inclusive Volume— Dispositim Item No. Dates In Aiffon" i 00 Ctbic Comp titles Feet AuthorlceLlon bsl-SL .fie. ,P�✓�-ru_e-e- 5 ', �1 p l . S 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have be --I 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 Print Name: Lori McWilliams, MG Print Title: Village Clerk Date 1 1A A l I f I Signature Print Name Print Title NOTE: upon dispositlon retain this form for vour records ,Light gray shading indicates a field required to be completed by department. ' Light blue requires a signature Date Print Form RECORDSDISPOSMON DOCUMEW Revised : 1/22/14 I PAGE AGES 1. AGENCY 2. DEPARTMENT 3. BUREAU Village of Tequesta I'-� Gc-( 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 INTEMMN 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 ttem B are to be disposed of in the litigation pending or imminent manner checked below (specify only one): On.'y thg Depz of Haad has the au;hority to sign ct1 on !t.m 6. dq Signature C�///l�A(I/b1,�ate ©/i/9 Name -roUQ— Title / r'e B. LIST OF RECORD SERIES a. b. C. d. e. f, g- schedule item Title Retention Inclusive Volume DispnsitiOn in Adtidn and DOu Iterrt NO. Cubic arctic Compw"j After Feet: AuthorirfWn 701 oYfS : M S �! Z6D9 -5 �S 8. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above fisted 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 J� 6 M f, ;'l _ Print Name: Lori Name: Lori McWilliams, MMCMMC Print Title: Village Clerk Date I I AA I 191 I Signature Print Name Print Title NOTE: Upon disposition retain this form for your records _ight gray shading indicates a field required to be completed by depaliment. -ight blue requires a signature Date Print Form 4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Nagle 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 INTEN M N 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 8 are to be disposed of in the litigation pending or imminent. manner checked below (specidy only one): pr,?y tha D ep Z 5pcyt H�.d has the aut!-,0rfty fo sig,77 Off of ftem Signature -Tiate Blame / ✓l �/ Title S. LIST OF RECORD SERIES a. b. C. schedule (tern Tftle Ittm NO. d. e. f. 4• Retention Inclusive Volume Disposetion Dates In A Con " D910 Cf itaiz Ctimpiebed Jk er Feet Authari ebri �75+ ?D Pun 9. DISPOSAL AUTHOPJZATIO14: Disposal for the above listed records authorized. Any deletions or modifications are indicated Signature r�,t, (��� Date , � t o. 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) Si Batenature �) /! g �D z Print Name: Lori McWilliams, M141C Print Flame Print Title: Village Clerk Print Title NOTE: upon disposition retain this form for your records Light tray shading indicates a field required to be complete Light blue requires a signature y deparlment. 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Rr-.1 gpjG-j pajnPQti-2si. spiaoei aq; !ol sluawailnba9 llpne Aue IBLl; °Molaq poluesa3dai Al;aa.uoo �0i9 T73La�1 dO 3Ou Ot i 't eju;o pasodsip aq o; spjoaal aql lull Ajp, a Agaaay l -,ke a3.LLiWSnS "9 ottlo-89L- L99 69-KS 1-� `UjSanbas O]UV 'swe1111MoiN uoj anla(] elsenbal 9t£ (joqunN euogdala,L pus awu N)1OVINOO 'S (apoO dIZ pua `�}l� `laaalS) SS3L1OflV "� d/N f1b3�3118 '£ 10 5 /� -elsoribei io e6ull!h .Ld+i3]"ISL�V�13©'l A�%+13J1f "l t7l/37/L : paSinaU S. LIST OF RECORD SERIES a. b. C. d. e. f. 4- scfvdule ftem Title Retention fncfus"ire Volume Disl=s io" n ram �o. Dates in A eCm and € lift Ctibio 01MRWWd A1fter Feet AiaCfiariC4'14?n C�sq- +70 Pt u) jf .es 12/2,�O8-OI ,s 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have been disposed of in the manner and on the date shown in column g. authorized. Any deletions or modifications are indicated (Witness to the Records Disposition) Signature n ' Date Signature n Date Print Name: Lori NiOWIirlams, ffIIAC Print Name Print Title: Village Clerk Print Title NOTE- Ur)on disposition retain this form for your records ight Gray shading indicates a field required to be completed by department. Light blue requires a signature Print Form S. LIST OF RECORD SERIES a. schedule b. Item C. d. e. Tuttle Retention Inclusive Dates f. Yolurnre in 9- Disposeion }41t' on " Baba Itetn No. Guttia Cs2 mpmed ftEter Feet Authori+ eion AS4 46 1 ,eun arts : 5-MS ivgsi 8" 2ov9- 9 15 9. DISPOSAL AUTHOMATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have bears 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 n,y Date I Signature Date D /1, Print Flame: Lori McWilliams, IAJAC Print Name Print Title: Village Clerk Print Title NOTE: Upon disposition retain this fonn for your records .fight tray shading indicates a field required to be completed by depaiiment fight blue requires a sionature Pant Form Revised: 1/22/14 140. 01- Ig PAGE- d? � PAGES I.AGENCY 2. DEPARTMENT 3. BUREAU Village of Tequesta 1f2u_ GU'�- I 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 INTEMT DN 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 8 are to be disposed of in the litigation pending or imminent. manner checked below (specify only one): Only tf e Dep ni H�:d has lh- au 'hi to sign ctf ifs ?Earn G. /� r SignatureLJ26�0 Date / Name Vile 8. DISPOSAL AUTHORIZATION: Disposal for the above fisted records authorized. Any deletions or modifications are indicated Signature M Data ' 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 Bate 2 9 Print Name: Lori McWilliams, IAMC Print Name Print Title: village Clerk Print Title NOTE: upon disposition retain this fon-n for vour records ight gray shading indicates a field requ Light blue requires a signature to be completed by department. Print Form