HomeMy WebLinkAboutDispositions Forms_62-21_7/14/2021_Public WorksNO.
RECORDS DISPOSITION DOCUMENT
PAGE l OF i 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
b. 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 been fully justified, and that further retention is not required for any litigation pending or imminent.
Sign ture 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
Dates
f.
Volume
in
g.
Disposition
Action and
No.
No.
recce � 1kau � le y
Cubic
Date
Insert "a"
or "b"
�p j'Qtj a+^
Feet
Completed
After
after item
# (247b)
Authorization
)(3 9
1 1
0.01
,9810,
4
-
1o�jl
ITz.
0•07
4
L
s
iIc
TOTAL CUBIC FEET THIS PAGE:
i
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�el�etionnss or modifications are indicated.
*,teV
4
Records Liaison Officer Signature Date
Signature
Name/Ti le
Routin :
1. Originates with Department Senior Manager, then
2. Village Clerk's Office authorizes disposition, and returns to
1. Originates with Department Senior Manager, then
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
4. Completed form to Village Clerk's Office for permanent
records
3. Clerk's Office will be responsible for final disposition of
archival
records at this point Form Updated: 4/11/18, 1/26/21
OR