HomeMy WebLinkAboutDispositions Forms_45-18_8/22/2018_FinanceNO. 45-18
RECORDS DISPOSITION DOCUMENT
PAGE 1 OF 1 PAGES
1. AGENCY NAME and ADDRESS
2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA
Number)
345 Tequesta Drive
Lori McWilliams, MMC
Tequesta, 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).
Qa. Shred at Department Level c. Send to Storage until e. Recycle
Disposition Date Met
Qb. Send to Storage for Shredding 0 d. Removed from Server f. Other
4. SUBMITTED BY:
I hereby certify that the records to be i posed of are correctly represented below, that any audit requirements for the
records have been full justi d, t at further retention is not required for any litigation pending or imminent.
Chris Quirk 08/22/18
SioNture Name and Title (Senior Staff only) Date
a.
b.
C.
d.
e.
f.
g.
Schedule
Item
Title
Retention
Inclusive
Volume
Disposition
No.
No.
Dates
in
Action and
Cubic
Date
Feet
Completed
After
Authorization
GS14
113
Utility Customer Records
3 FY
1/1/16 - 9/30/16
4
TOTAL CUBIC FEET THIS PAGE:
4
6. DISPOSAL AUTHORIZATION: Disposal for
7. DISPOSAL CERTIFICATE: The above listed records have been
the above listed records is authorized. Any
disposed of in the manner and on the date shown in column g.
deletions or modifications are indicated.
Records Liaison Officer Signature Date
Signature Name/Title Date
1. Originates with Department Senior Manager, then
1. Originates with Department Senior Manager, then
2. Village Clerk's Office authorizes disposition, and returns to
2. Village Clerk's Office authorizes disposition and/or storage
3. Originating department to dispose and document column g,
at the storage room and will contact Public Works to remove
then sends
records"
a. Completed form to Village Clerk's Office for permanent
3. Clerk's Office wiliponsible for final disposition of
Form Updated; 4111/18