HomeMy WebLinkAboutDispositions Forms_39-15_6/9/2015_FinanceRevised 09/02/14
RECORDS DISPOSITION DOCUMENT
NO.
PAGE I OF PAGES
1. AGENCY
Village of Tequesta
2. WATER UTILITES/CUSTOMER SERVICE
3. BUREAU
N/A
4. ADDRESS (Street, City, and Zip Code)
5. CONTACT (Name and Telephone Number)
345 Tequesta Drive
Lori McWilliams, CIVIC
Tequesta, FL 33469
561-575-6200 ext. 244
6. 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
The scheduled records listed in Item 8 are to be disposed of in the
litigation pending or imminent.
manner checked below (specify only one):
Da. Destruction b. Microfilming and Destruction
Signature Date
,J
a.1 Shred F�!L a.2 Recycle
(� �S
c. Imaging and Destruction
d. Other
Name and Title RENEE REBECCHI /CUSTOMER SERVICE
8. LIST OF RECORD SERIES
a.
Schedule
Item
b.
Item
No.
C.
Title
d.
Retention
e.
Inclusive
Dates
f.
Volume
in
Cubic
Feet
g.
Disposition
Action and Date
Completed After
Authorization
1-43
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9. DISPOSAL AUTHORIZATION: Disposal for the above listed records
authorized. 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: �^ Date:A0 J
Print Name: Lori McWilliams
Print Name:
Print Title: Village Clerk
Print Title:
NOTE: Upon disposition retain this form for your records
Revised 09/02/14
RECORDS DISPOSITION DOCUMENT
NO. �X —1
PAGE o1.OF PAGES
I.AGENCY
Village of Tequesta
2. WATER UTILITES/CUSTOMER SERVICE
3. BUREAU
N/A
4. ADDRESS (Street, City, and Zip Code)
5. CONTACT (Name and Telephone Number)
345 Tequesta Drive
Lori McWilliams, CIVIC
Tequesta, FL 33469
561-575-6200 ext. 244
6. 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
The scheduled records listed in Item 8 are to be disposed of in the
litigation pending or imminent.
manner checked below (specify only one):
X—�a. Destruction 0 b. Microfilming and Destruction
Si a Date
a.1 Shred [� a.2 Recycle
c. Imaging and Destruction
0 d. Other
Name and Title RENEE REBECCHI /CUSTOMER SERVICE
8. LIST OF RECORD SERIES
a.
Schedule
Item
b.
Item
No.
C.
Title
d.
Retention
e.
Inclusive
Dates
f.
Volume
in
Cubic
Feet
g.
Disposition
Action and Date
Completed After
Authorization
GS-14
113
UTILITY CUSTOMER RECORDS
3 FISCAL
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►�I� ��
9. DISPOSAL AUTHORIZATION: Disposal for the above listed records
authorized. 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: Date:
Print Name: Lori McWilliams
Print Name:
Print Title: Village Clerk
Print Title:
NOTE: Upon disposition retain this form for your records