HomeMy WebLinkAboutDispositions Forms_42-18_8/22/2018_Financet)1, p % 1yl r 111
RECORDS DISPOSITION DOCUMENT PAGE / OF PAGES
1. AGENCY NAME and ADDRESS 2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA Number)
345 Tequesta Drive Lori McWilliams, MMC
Te uesta, 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).
0 a. Shred at Department Level c. Send to Storage until O e. Recycle
Disposition Date Met
0 b. Send to Storage for Shredding O d. Removed from Server Q f. Other
4. SUBMITTED BY:
I hereby certify that the rec ds to be disposed of are correctly represented below, that any audit requirements for the
records have een y ' s fied, and that further retention is not required for any litigation pending or ' mine t.
CWI's av, /K h na,1c��'x�
Signature Name and Title (Senior Staff only) 6ate
5. LIST OF RECORD SERIES
a.
Schedule
b.
Item
C.
Title
d.
Retention
e.
Inclusive
f.
Volume
g.
Disposition
No.
No.
Dates
in
Action and
Cubic
Date
Feet
Completed
After
Authorization
GS1-SL
358
PENSION RECORDS: PLAN/FUND
5 FYS
OCT'12 - SEP'13
TOTAL CUBIC FEET THIS PAGE:
to ,
6. DISPOSAL AUTHORIZATION: Disposal for
7. DISPOSAL CERTIFICATE: The above listed records have been
bove listed records is authorized. Any
disposed of in the manner and on the date shown in column g.
ons or modifications are indicated.
4leti
L
Records Liaison Officer Signature Date
Signature Name/Title Date
Ro
1. Originates with Department Senior Manager, then
2. Village Clerk's Office authorizes disposition, and returns to
3. Originating department to dispose and document column g,
then sends
4. Completed form to Village Clerk's Office for permanent
archival
Originates with Department Senior Manager, then
Village Clerk's Office authorizes disposition and/or storage
at the storage room and will contact Public Works to remove
records
Clerk's Office will be responsible for final disposition of
records at this point
Form Updated: 4/11/18