HomeMy WebLinkAboutDispositions Forms_66-19_3/2/2020_Utilities It P
NO.
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
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).
a. Shred at Department Level G "' Send to Storage until ee. Recycle
Disposition Date Met
b. Send to Storage for Shredding d. Removed from Server U f. Other
4. SUBMITTED BY:
hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the
records have bee Ily justified,and that further retention is not required for any litigation pending or imminent.
1,
I'Ahlk
Signature Name and Title (Se or Staff only) Date
5: LIST OF ECORD SERIES
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
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.
d lN
tlionsoxWd&
modifications are indicated.'� A, IAI&IJ I
Records Liaison Officer Signature date nature Name/Title Date
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1 Originates with Department Senior Manager then �� �� _`: �, Onginates withDepartmentSenior`Manage�then
2;, Village Clerk s Office aufhonzes-disposition, and returns to 2 Village Clerk`s Office authonzes tlis NQ§5on anM.
d/or sfor�ge
3 Ongmatirigdepartment todispose and document colurr�n g, at the storage room and will contact Puplic Works to remove
4' Completed;form to Vi{lage Clerks Office for permanent- 3 Clerks Office wilt be`responsible for final dyspos►fion of
archival records at this pant � � � �=
_ _ Form Updated X4/1111.8
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