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Home My WebLink AboutDispositions Forms_02-18_1/9/2018_FireRECORDSIl ft DOCUMENT . Da -I S Revised: 1/22/14 tPAGEOf � PATES i.AGENCY 2. DEPARTMENT UVillalge of Tequesta � fl Y19� �- 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 INTENTKIN correctly represented below, that any audit requirements for the records have been fully justified, and that further retention is not required for any The manner d below records listed in Item 6 are Iry dispessad of in ^ litigation pending or imminent manner checked belo4r (spxify only erne}: Or,?y the Dap.:nr-Enf H&Ld has to 5�9n GTY 0.1 J.-rm Signature ij/j/ rAl w i to Name Title a. Schedule Ittm (�Sl-sl na- 6. LIST OF RECORD SERIES b. C. d.�- Ctem Title Retention Inclusive Ymlume lDispositira-51 f No. Dates In eton and DOM CtLbic 0ampiewd Ater Feet Aut[ro�riai�rn �2 �Adl'Y1,i �'listYG(�"i 1�. SSA- at-D � u � o�OIS I • �" IL; c ova o l •S 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records authorized. Any deletions or modifications are indicated Signature �aLq)&a;- Date Print Flame: Lori McI illiams, IAMC Print Title: village Clerk 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 Print Title NOTE: Upon disposition retain this form for your records Light gray shading indicates a field required to be compete Light blue requires a signature y cepan,meni. P6r Form RECORDS DISPOSITION DOCUMENT Revised: t/L2/t4 PAGE Of 1 PAGES I.AGENCY 2 DEPARTMENT & BUREAU Village of Tequesta N/A 4. ADDRESS (Street, City, and Zip Code) 345 Teguesta Drive Marne and Telephone Number) CONTACT 5. ( Lori McWilliams; MMC Teguesta, FL 33469 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 T. NOTICE OF INTENTMON The scheduled rerx+rds listed in (fern a are to be disposed of in tive manner checked below (specify only' one): Only tt,a D=Yen , t d t tk. s✓,hority to sign cIt.r-a E. 5-` ed Signature I �O Name IJ �j X 4'0_ I f a_ Title ► l _c S. LIST OF RECORD SERIES a. b. C. Schedule item Tide Item Ito. d. e. Retention Inclusive Volume Disposlti'an Dates in Aierm" i OD (>jbie Oampleb!d 1kner Fedt Authorketbn C�sl-S� -#2 19E�Cmi (I Lsfr ai 14 cqpj3- 2o74 s IS 9. DISPOSAL AUTHORtZATiON: Disposal for the above listed records authorized. Any deletions or modifications are indicated 0 31 Signature � �,,: Yi��n-�— Date 1 � 10. DISPOSAL CERTIFICATE The above listed records have beem"I disposed of in the manner and on the date shown in column g. (Witness to the Records Disposition) Signature w- Datep/ 19 Print name: Lori McWilliams, IAIJC Print Name Print Title: village Clerk Print Title NOTE: Upon disposition retain this form for vour records (Light gray shading indicates a field required to be completed by department. Print Form (Light blue requires a signature Revised: 1/22/14 i. ACENCY 2. DEPARTMENT Village of Tuesta I r► I 1+0. C)9 - I r PAGE 3 OF PACES &. BUREAU 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 S. 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, rds listed in 90 are to be disposed of in the litigation pending or imminent oc manner checked below (G� y ): Orly . dhas ih. u. orfty to sign offal Item 6. Jn h r Signature ate � j/ J IJC1lJ Name Title f S. LIST OF RECORD SERIES a. b. Schedule Item C. Title d. Retention e. Inclusive Volume In DisizSwan Action and i� Ittrrt No. Dates (?lieu-. CFjmpwb!!d Atef Felt Authorlettion CAI -SI. ->S�2 {�n1i nisj70d,. CQ 6A goo - 2,9 1. s" Can V(Wi1A aQ-- l•5- 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. (lrltness to the Records Disposition) Signature XL. 1 1 jai Date Ida 11 Signature ,?/ Date /o Print Name: Lori ii CIVilliams, IAMC Print Name Print Title: Village Clerk Print Title NOTE: Upon disposition retain this form for your records Light gray shading indicates a field requi Light blue requires a signature to be completed by department. Print Form RECORDS DISPOSMON DOCUMENT Revised: 1/22/14 PAGE f- of: I I PAGES 1. AGENCY 2. DEPARTMENT 3. BUREAU Village of Tequesta I vm' poaq mom- N/A 4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Harne 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 T. NOTICE OF INTENTION correctly represented below, that any audit requirements for the records have been fuily justified, and that further retention is not required for any The scheduled records listed in Item 6 are to be disposed of in the litigation pending or imminent manner checked babes (specify onlg one): Gniy it;a D_p - f Ham.. d h<as th= su hority to Sign 0(1 coIt c> C. Signature 0M��Date 0l/b9 Ilyj flame Title/ /1;� (�.(•�� `' S. LIST OF RECORD SERIES a. b. C. d. e. f. g- Schedule ftem Trftle Retention tncluslve Yaiurne iiispOslti�n item Ko. Dates in Action and DRIP Cubic C*mRWJ?! After Feet ALtthoricatiol C�sl-�� Z m/n�tru�i tee. 0S-A 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records authorized. Any deletions or modifications are indicated Signature A it� f - Date i IA31 l � 10. DISPOSAL CERTIFICATE The above listed records have bem..n disposed of in the manner and on the date shown in column g. (Witness to the Records Disposition) Signature I h1&U-- Date Print Name: Lori McWilliams, IJIMC Print Name Print Title: village Clerk Print Title NOTE: Upon disposition retain this form for your records ight gray shading indicates a field required to �,e compei Light blue requires a signature dI parl.ment. Print Form RECORDSDISPOSMON DOCUMENT Revised: 1/22/14 PAGE 5 OF 7 PAGES 1. AGENCY 2. DEPARTMENT & BUREAU f N/A Village of Tequesta tnk 4. ADDRESS (Street, City, and Zip Code) 345 Tequesta Drive Tequesta, FL 33468 5. CONTACT (Name and Telephone Number) Lori McWilliams, MMC 561-768-0440 6. SUBMITTED BY: I hereby certify that the records to be disposed of are correctly represented beiaw, 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 Lt,e D_p::�t H=.. d has to sign off all Item 6. 7. NOTICE OF INTENTION The scheduled records lisp in Item 6 are to be disposed of in the manner checked below (Spector only one): s IF Signature Date � / Q Title S. LIST OF RECORD SERIES a. b. C. d.q- Schedule Item Title Retention Inclusive Volume Y'Sws%:ran 1Rtm No.Nies in ? on arrd i to Guhic E3amj-,!sTr--1 AEt�r Feet Ruih_r�atn oelf -tiV 20 - 202 l � �60V-e-n1,.e iCC- �s 9. DISPOSAL AUTHORIZATION: Disposal for the above Fisted records authorized. Any deletions or modifications are indicated Signature �,� l Y l t/y Date I �' I f ( 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 Disposltion) �� Date �p 9 Signaturei—, "'� - Print blame: Lori McWilliams, NIVIC Print Name Print Title: Village Clerk Print Title NOTE: Upon disposition retain this forrn for your records t cray shading indicates a field required to be completed by depar-lment. Light blue requires a signature Print Form 4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number) 345 Tequesta Drive Lori McWilliams-, MMIC Teguesta, 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 is not required for any The scheduled records listed in Item & are to be disposed of in the litigation pending or imminent. manner checked below (specify only one): Only the D ,f Ye:.d has ff z ul'h'o ity to sign off a-i Item 6. / Signature ate D QCr /g Name /a Title! 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 ((� jy Date I ] 3 o� Signature 4, Date / Print blame: Lori McWilliams, fAlJC Print Name Print Title: Village Clerk Print Title NOTE: upon disposition retain this form for vour records ight crag shading indicates a field required to i✓e comp!eie Light blue requires a signature aepan.meni. Print Form 4. ADDRESS (Street, City, and Zip Code) 345 Teguesta Drive Tequesta, FL 33469 5. CONTACT (Name and Telephone Number) 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. On!y tta DapL5PPOV Fe d hss the av +.ority to sign c(t arl Hann 6. T. NOTICE OF ENTENT)ON The scheduled records listed in Item 8 are to be disposed of in the planner checked below (sieeffy onDy one): p Signature Name Title TJ( /"�a— L-Lo 8. LIST OF RECORD SERIES a. b. C. d. e. f- g Schedule stem Tide Retention inclusive Y41ums Di pusffivn Ittrn No. Dates in Adtim"Data Cr>tria. Campwhed After Feet Authork9tion . l.S 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records authorized. Any deletions or [modifications are indicated Signature i� jy Date 11 I 1 10. DISPOSAL CERTIFICATE The above listed records have been disposed of in the spanner and on the date shown in column g. (Witness to the Records Disposition) �w Signature r /// f� DatePrint Name: Lori MclYllllams, IAMC Print Name Print Title: Village Clerk Print Title NOTE: Upon disposition retain this form for your records ight tray shading indicates a field required to re compete Light blue requires a signature y depaliment. Print Form Revised: 1/22/14 40. as -11 PAGE g Of 19 PAGES 1. AGENCY 2. DEPARTMENT Village of Tequesta --FI rl c & BUREAU 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 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 8 are to be disp000d of in them litigation pending or imminent Manner checked below (specify only one): Orly ti;e D!^n f Ha .ere ilia authority to sign off err etc 7 6. Signature Name Title 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have bem..n 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 Date I O� y Signature r 2 D to Print game: Lori McWilliams, IAJAC Print Name Print Title: village Clerk Print Title NOTE: Upon disposition retain this form for your records Light Cray shading indicates a field required to be completed by department. 11ght blue requires a signature Print Form 8. LIST OF RECORD SERIES a. b. C. d. e. f, g- schedule Itern Tale Retention Inclusive Volume DisposAbn 11em NO. Dates in Aeft7on and Dote Ctfbic Csa npWtPd JUtes Few Authorka'tbn 8 1 ns ern a,nd Maa rmznan �- 05-9 200q - .16 to 1. S "Coyco �6 -SL �2 i�elm►�1 isi-rGt� uQ 0mfnv x), e_f o - I s 8. DISPOSAL ALri-HORIZATION: 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 �) a� [Yl Md Print blame: Lori McWHIlams, IAIJC Print Title: Village Clerk Date l 14 d l 1 3 1 Signature Print Name Print Title NOTE: Upon disposition retain this fon-n for your records Light gray shading indicates a field required to be completed by department. Light blue requires a signature Date Print Form Revised: 1/22/14 PAGE f0'= �� PAGES i. AGERCY 2. DEPARTMENT & BUREAU Village of Tequesta j 1�—�(_J.P :� 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 INTEBITl N 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 rcerinfs listed in Item 6 are to bee disposed of in the litigation pending or imminent, manner checked below (spec?fy only Oita): pn?y u;e DIzInant H has &,4. srt .O to sign off an Item 6. Signature dait Hate 61 l oqI /g h ttarne tde_� 1 a— ) Title�-//,(� S. LIST OF RECORD SERIES a. b. C. d. e. f. 1- schedule Stem TEtfe Retention Inclusive YaIunla Disposftiafi lttm No. Dettes in Adtbri and DWW Cubic € ampGt'"j Attcr Feat �kt�tlx�retian "olsfto-" we- 60 van v-n 0-e- to// o i ................... 9. DISPOSAL AUTHORIZATIO14: Disposal for the above listed records I t o. DISPOSAL CERTIFICATE The above listed records have been authorized. Any deletions or modifications are indicated Ij disposed of in the manner and on the date shown in column g. (Witness to the Records Disposition) Signature ( Date 1,a311 k Signature ` Date Print Name. Lori McWilliams, IA[AC Print Name Print Title: Village Clerk Print Title NOTE: !loon disposition retain this form for your records gray shading indicates a field required to be complet Light blue requires a signature department. Print Form RECORDS , . DOCUMENT ram. Off . -- i k Revised: 1/22/ 4 PA13E (L OF If) PALES 1.AGFNCY 2. DEPARTMENT & BUREAU Village of Tequesta / -� N/A 4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (lame 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 T. NOTICE OF INTENMN 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 6 are to be disposed of in Vie litigation pending or imminent manner checked below (specify only one): On?y tfie Der- . , f Hr d has the au orify to sign offal) Item 6. Signature Name �0 a - --t4tjQ6' Title -Ans- 8. LIST OF RECORD SERIES a. b. C. d.g- Schedule 6teai Tide Retention Cnclusiive Volume- Di•,{nasffi= I"itm No. Dames In A dtion ng Dvtm Cubic € ojmpWbed Jk?W %mot ALithorkkttion MMEI�= ,ME , ,• t .S 8. DISPOSAL AUTHORIZATION: Disposal for the above listed records authorized. Any deletions or modifications are indicated Signature „,y hate ► la 3 I � � 10. DISPOSAL CERTIFICATE The above fisted records have been disposed of in the manner and on the date shown in column g. (Witness to the Records Disposition) Date Signature � ZI17 g �v 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 dEpaltment. Print Form Light blue requires a signature 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: 1 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 HsW in ttem 8 are to be disposed of in the litigation pending or imminent manner checked below (specify only one): Only the Dep ca-7t !�d has the authority to sign off on Ilan &. Signature Date Name Title 8. LIST OF RECORD SERIES a. b. C. d. e. f. 9- Schedule Item Title Retention Inclusive Volume Disposition Item No. Dates in Action and Date Cubic Completed Auer Feet Authorization M CU' tit �ecard� 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records authorized. Any deletions or modifications are indicated Signature �,i Fi' Date , la 3 I I & 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 !p Print Name: Lori McWilliams, MMC 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 Revised : 1/22/14 PAGE L3OF 1'1 PAGES 1. AGEW-y 2. DEPt RTKENT 3. BUREAU Village of Toquesta -fli �� tr��- NIA 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 T. NOME OF INTEN'WN 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 Kern 9 are to be disposed of in ttrm litigation pending or imminent. manner checked befaw (specKy only One): Only ihz D_ . rz :if Pd hos ih2 aulhorif fo sign off On lfem 6. Signature ` Dat O I lI (K cto ��A Name Title :rj ✓u _ I 8. LIST OF RECORD SERIES a. b. C. d. e. Schedule item Title retention inclusive Volume Dispusmon iltdSi MO. Dates in Adron arm Dote CG.lia 0ampiebed Ater Feet Authoricctran 0 p- 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 1 o. 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 �,L %i�y Date lid 3 I l y Signature Date 1DI, Print Name: Lori MaWilliams, 1,AMC Print Name Print Title: Village Clerk Print Title NOTE: Upon disposition retain this fon-n for your records Light gray shading indicates a field required to Light blue requires a signature completed by department. Print Form -D•• • DOCUMENTlam. Revised: 1/22/14 PACE QF j7 PACES 1. AGENCY 2. DEPARTMENT 3, BUREAU Village of Te luesta N/A 4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number) 345 Teguesta Drive Lori McWilliams; MMC Tequesta, FL 33469 561-768-0440 6. SUBMITTED BY: I hereby certify that the records to be disposed of are T. NO=E OF INTENMN 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 hem & are to be disposed of in the litigation pending or imminent manner choked below (specify only orle): Orly tha D � n �l K = as the oL&crlty to sign oft o.-) 1"";m 6. Signature ate I l to%I Sh VI.fd O Name Title T t S. LIST OF RECORD SERIES a. b. C. d. e. f. 9- Schedule Item "title Retention Inclusive Volume Disposition lttm Dates in Aeon and €�Ote Cubic OgmpGfted A'hes Feat Authori etbn �51 S1, Z rrv�si"YC(.;i i�l Vlv�.r� i Zvi Q_�- D A2JJ0��- �s i2�e�rd� I� 9. DISPOSAL AMOPMATION: Disposal for the above listed records t o. DISPOSAL CERTIFICATE The above listed records have bey 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 '� Uf'�) &,f)A Date �, I�� Signature �r Date Print Name: Lori McWilliams, MVIC Print Name Print Tilde: Village Clerk Print Title NOTE: Upon disposition retain this four for your records ight crag shading indicates a field required to to complete Light blue requires a signature eparlment. FriFnt Form Revised: 1/22/14 1. ACENCY Village of Tequesta 2. DEPARTMEN P"J.ya -1 k PAGE i5OF I'] PAGES 3. BUREAU N/A 4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (lame 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 T. NOTICE OF INTENMN 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 On?Y One): Only tea D= a,2 He= .as J-,a outhcrRy.10 sign cry al Ram 6. itate c n 6 00, Signature Q i Oq I J Flamemt—chaa Title -i:i nQ, S. LIST OF RECORD SERIES a. b. C. d. e. f. 3- Schedule Gtem Title Retention Inclusive YWun-R Di'osftiDn Item �o. Dates in Adron and DON Cjb.ic CsrmpWb�d lk tcs Feet Ar�th4ricatcon UJf IV on ;-a)3 l •S 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records authorized. Any deletions or modifications are indicated Signature n,L E I ly Date 11 of I I S Print Name: Lori McWilliams, IAMIC Print Title: village Clerk 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 1��./ Date Print Name Print Title NOTE: Upon disposition retain this fon n for your records Light gray shading indicates a field required to be complet Light blue requires a signature department. Print Form 4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number) 345 Tequesta Drive Lori McWilliams., M MC Tequesta, FL 33469 561-768-0440 6. SUBMITTED BY. I hereby certify that the records to be disposed of are 7. NOTICE OF INTE[ZMN 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): 0,,!y ite Der .e;t NV d has tte a uJI city to sign ctf on kam 6. ��M-d Signature Date I Name I,- .L Title K� 8. LIST OF RECORD SERIES a. b. C. Schedule Item Title Ittrn No. d. e. Retention Inclusive Dates f 9 Volume pispbsit"raan in fioerzi anod Dem Cubic 02mi?W5ed Mier Feet Authoriefion OSA 2-0q -261 a I , s v ta" fLA l.s 9. DISPOSAL AuTIJORiZATION: Disposal for the above listed records authorized. Any deletions or modifications are indicated Date Signature �m a I�G 10. DISPOSAL CERTIFICATE The above listed records have bean disposed of in the manner and on the date shown In column g. (Witness to the Records Disposition) Signature �(� 2 Print game: Lori McWilliams, IAMC Print Titie: Village Clerk Print Name Print Title NOTE: Upon disposition retain this form for your records Light gray shading indicates a field required to be completed by deparitment, Light blue requires a signature Print Form Revised: 1/22/14 NO. Oa. --19 PAGE 19OF If) PAGES i. AGENCY I2. DEPARTMENT 3. BUREAU Village of Tegrlestay� k, &Juxyz_ 9Y fftNA 4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Nance and Telephone Number) 345 Tequesta Drive Lori McWilliams-, MMC Teguesta, FL 33469 561-768-0440 6. SUBMITTED BY: I hereby certify that the records to be disposed of are 7. NOTICE OF INTF_I Mhl 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 tiern 6 are to be disposed Of in t v-, litigation pending or imminent. manner checked below (specffl OnlY one): Only tte DeFs H d h's th,a ;u:h .rity to sign C'TY on k; -'m G. gV� Signature ate I O 1 Name �.Q�ll (i� Title( Vr% C S. LIST OF RECORD SERIES a. b. C. d. e. f. g- Schedule Item Title Retention Inclusive Yolume Iilsizsftbn Item No. Dates in A4'tibrl anod Difte E .b!2 Cbmpwbed }Mier Feet Authorleetion Cis -S L f ah OS-d 16 2,012� -C)q I.5 fLCadA 1 ^^hh 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records authorized. Any deletions or modifications are indicated Signature m /� ,1� Date I u Ilk Print Name: Lori Name: Lori McWilliams, IJti41C Print Title: village Clerk 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 Print Name Print Title NOTE: Upon disposition retain this fon-n for your records ight gray shaving indicates a field required to be comp!et Light blue requires a signature department. Date / Print Form