HomeMy WebLinkAboutDispositions Forms_87-21_9/21/2021_ClerkNO. 87-21
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1. AGENCY NAME and ADDRESS
2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA
Number)
345 Tequesta Drive
Lori McWilliams, MPA, MMC, (561) 768-0443 or
Tequesta, FL 33469
Mary Ann Grieser, CMC, (561) 768-0445
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. Remove from Server f. Other
4. SUBMITTED BY (Department Head/Senior Staff Member Only):
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.
Lori McWilliams pae 20Z9092113by 2 McWilliams ' Lori McWilliams, Village Clerk 09/21/202�
Signature Name and Title (Dept. Head/Senior Staff only) Date
MCA
a.
Schedule
b.
Item
C.
Title
d.
Retention
e.
Inclusive
f.
Volume
g.
Disposition
No.
No.
Dates
in
Action and
Cubic
Date
Feet
(completed After
Authorization
GS1-SL
2
ADMINISTRATIVE CONVENIENCE
OSA
1973-2021
1
Recycled
RECORDS
9/21 /2021
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.
deletions or modifications are indicated.
Lori McWilliams pa 12219;Y1321:22- O 09/21/2021 Lori McWilliams VC0"�ge"Y`° Village Clerk 09/21/2021
Date: 2021.09 21 13'.2112-04'00'
Clerk's Office Signature Date Signature of Person Disposing of Records Name/Title Date
/%/
,,,originates with Department Senior Manager, then 1 Originates with Department Senior Manager;"theny
Village Clerk's Office authorizes disposition, and returns to Z. Village Clerk's Office authorizes disposition and/or"ora
Originating department to dispose and document column g, % at the storage roam and wall contact Public SPX„ t�} ye-
n sends �„
iON
/.recor!ow1
Clerk's C rCe""
wi e responsible for- final disposition of
/,Te rd h, t
o�arrrt
Updated 9121/2