HomeMy WebLinkAboutDispositions Forms_19-21_4/5/2021_Storage UnitRECORDS 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).
Qa. Shred at Department Level O c. Send to Storage until Qe. Recycle
Disposition Date Met
0 b. Send to Storage for Shredding Q d. Removed from Server Of. Other
4. SUBMITTED BY:
I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the
recorqs1have fully justified, and that further retention is not required for any litigation pending or imminent.
MOA,-t--been
XI'I' L6rn tflc 011kiwS, 01*[i Cj�,VL «la3 did�r�
Signature Name and Title (Senior Staff only) Date
5. LIST OF RECORD 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
` n n ��
0-2-
--
it
►�
oZ
L
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
sposed of in the manner and on the date shown in column g.
d etions or modifications are indicated.
1/141 Z
L(
Re r s Liaison Officer Signatu Date
SicHafure Name/Title Date
Routin
:
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
4. Completed form to Village Clerk's Office for permanent
3. Clerk's Office will be responsible for final disposition of
archival
records at this point
Form Updated: 4/11118
OR