HomeMy WebLinkAboutDispositions Forms_75-21_8/23/2021_ClerkRECORDS DISPOSITION DOCUMENT
PAGE 1 OF 1 PAGES
1. AGENCY NAME and ADDRESS
2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA
Number)
345 Tequesta Drive
Lori McWilliams, MMC
Teguesta, 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).
0 a. Shred at Department Level O c. Send to Storage until O e. Recycle
Disposition Date Met
Ob. 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 Pfe been fully justified, and that further retention is not required for any litigation pending or imminent.
x I A", ffi Lori McWilliams 08/04/21
Signature Name and Title (Senior Staff only) Date
5. LIST OF RECORD SERIES
After the Item V, place an "a" for.recor+d copy or "b" or Diu pr cate.
a.
b.
C.
d.
e.
f.
g.
Schedule
Item
Title
Retention
Inclusive
Volume
Disposition
No.
No.
Dates
in
Action and
t,sert"a"
Cubic
Date
or "b°
Feet
Completed
after item
After
# (247b)
Authorization
GS-3
143a
Campaign and Registration Records
Candidates
10 AY
2001
.10
Sh: Z
TOTAL
CUBIC FEET THIS PAGE: I,
10
6. DISPOSAL AUTHORIZATION: Disposal for
7. DISPOSAL CERTIFICATE: The above listed records have been
t e above listed records is authorized. Any
disposed of in the manner and on the date shown in column g.
eletions modifications ar indicated.
I i� l
M • G�S� A.Cl�,,� s �s �
Recolrds Liaison Officer Signature Date
Signature Na e/Title Date
Routing:
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: 4111/18, 1126/21
OR