HomeMy WebLinkAboutDispositions Forms_81-21_8/25/2021_ClerkQOCUM
///„ POSITION
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
Ub. Send to Storage for Shredding 0 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.
C7\(LLM toii frl AU)r,-S , 014k �ja-rl a./
Signature Name and Title (Senior Staff only) Date
r1111/0� i
a b. C.
d.
e.
f.
g.
Schedule Item Title
Retention
Inclusive
Volume
Disposition
No. No.
Dates
in
Action and
Insert "a"
Cubic
Date
or „b,.
Feet
Completed
after item
After
# (247b)
Authorization
GS1-SL
3
Administrative Support Records
OSA
2019, 2020
.025
Recy 8/25/21
TOTAL CUBIC FEET THIS PAGE:
6. DISPOSAL AUTHORIZATION: Disposal for
7. DISPOSAL CERTIFICATE: The above listed records have been
th above listed records is authorized. Any
ed of in the manner and on the date shown in column g.
etions or modifications are indicated.
Id
`
L
o �r Z�
Records Liaison Officer Signature Date
Signature Name/Title Date
riginates with Department Senior Manager; then / ,
w
1. Originates �tl�`Department Senior M6riager, then
Village Clerk's Office authorizes disposition, and retur�is to
2_ Village Clerk's Office authorizes disposition and/or storage .
Originating department to dispose and document column g,
at the storage room and will contact Public Works tp rem re
then sends
Completed form to Village Clerk's Office for
records
3. Clerk's Office
permanent
rckuvl �� ��
[ tS at # its Form Updated: 4111J1$ �7C
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