HomeMy WebLinkAboutDispositions Forms_68-19_2/12/2020_Utilities RECORDS DISPOSITION DOCUMENTPAGE / of 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).
(21'a. Shred at Department Level c. Send to Storage until 0 e. Recycle
Disposition Date Met
b. Send to Storage for Shredding d. Removed from Server 0 f. Other
4. SUBMITTED BY:
I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the
records have be fully justified, and that further retention isnot required for any litigation pending or imminent.
4WAIP,* 1
Signatufe Name and Title (Senior tall only) Date
5. LIST OF`RECO RD SERIES
a. b c d e - f 9-
Schedule Item Title Retention Inclusive Volume Disposition
No. No. Dates in Action and
Cubic_ Date
Feet Completed
After
Authorizption
�QIVI S{r61[
G5- L 371 A-rdOA(Vl QC°Coca s kk- —ao(4
TOTAL CUBIC (FEET THIS PAGE:
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.
letions or modifications are indicated.
�s Ise a�
Records Liaison Officer Signaturd Date ignature Name/Title D to
1 Ong�nates with Department
-M A'*then '_ 1 O�g�nates with Department Senor Manager,then
2 Vi'!age Clerk s Office authonzes disposifion, antl returns to 2 Village Clerk s Office authonzes disposition and/or storage`
3 Ongmatmg tleparfinent to dispose anddocument column g at thrm a
e storage oond will contact Public Works to remove
then sends reoortls = 3
4 Completed form to Village Clerk's Office for permanent: 3 Clerks Qffice will be responsible for final disposition of
archival records"et this point
_ Form Updated 4!11/18