HomeMy WebLinkAboutDispositions Forms_61-21_7/14/2021_Public WorksNO. (F — 01,1
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
ga.
w(specify only one).
Shred at Department Level 0 c. Send to Storage until 0 e. Recycle
Disposition Date Met
0 b. Send to Storage for Shredding O 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 een fully ' stified, and that further retention is not required for any litigation pending or imminent.
,0o'�1 —Z i,,, 6 r G -
Signature Name and Title (Senior Staff only) Date
5. LIST OF RECORD SERIES
After the Item #, place an "a" for record copy or "b" for duplicate.
a.
Schedule
b.
Item
C.
Title
d.
Retention
e.
Inclusive
f.
Volume
g.
Disposition
No.
No.
Dates
in
Action and
Cubic
Date
Insert "a"
Feet
Completed
or "b"
after item
# (247b)
After
Authorization
sL91
'1-1_g
Vefykr� Lay
394V
TOTAL CUBIC FEET THIS PAGE:
6. DISPOSAL AUTHORIZATION: Disposal for
the above listed records is authorized. Any
7. DISPOSAL CERTIFICATE: The above listed records have been
disposed of in the manner and on the date shown in column g.
eletions or modifications are indicated.
ce 0\11a ,
Records Liaison Officer Signature Date
Signature
Name/Title Date
Routin
1. Originates with Department Senior Manager, then
2. Village Clerk's Office authorizes disposition, and returns to
3. Originating department to dispose and document column g,
then sends
4. Completed form to Village Clerk's Office for permanent
archival
1. Originates with Department Senior Manager, then
2. Village Clerk's Office authorizes disposition and/or storage
at the storage room and will contact Public Works to remove
records
3. Clerk's Office will be responsible for final disposition of
records at this point Form Updated: 4/11/18, 1126121
OR