HomeMy WebLinkAboutDispositions Forms_56-21_7/23/2021_Public WorksNO. 5-(0 +—" oL
RECORDS DISPOSITION DOCUMENT PAGE I 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 c. Send to Storage until e. Recycle
Disposition Date Met
Gb. Send to Storage for Shredding 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
records have be ully justified, and that further retention is not required for any litigation pending or imminent.
)o4 Td(ww�l0✓^ a _ t- 1,4-t� �Y+Cc-`�a f rl- l � I
Signature Name and Title (Senior Staff only) Date
a. b.
Schedule Item
No. No.
5. LIST OF RECORD SERIES
C.
Title
du.plica�
(�otJitZActs1L2�5~a5 F�
d. e.
Retention Inclusive
Dates
f.
g.
Volume
Disposition
in
Action and
Cubic
Date
Feet
Completed
After
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.
l�etiions( or modifications are indicated.
Records Liaison Officer Signature Date
Signature
Name/Title D e
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
at the storage room and the "Clerk's Office" will contact
" % originating deaprtment then sends
Public Works to take the records to storage
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
OR
Form Updated: 10/7/19