HomeMy WebLinkAboutDispositions Forms_92-21_9/23/2021_Clerk
NO.
:3.32
RECORDS DISPOSITION DOCUMENT
PAGE OF PAGES
2
3
1.AGENCY NAME and ADDRESS2.AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTANumber)
345 Tequesta DriveLori McWilliams, MPA, MMC, (561) 768-0443 or
Tequesta, FL 33469Mary 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 Levelc.Send to Storage untile.Recycle
Disposition Date Met
b.Send to Storage for Shreddingd.Remove from Serverf.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.
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____________________________________________________________________________________________
Signature Name and Title (Dept. Head/Senior Staff only) Date
5.LIST OF RECORD SERIES
a.b. c. d. e.f.g.
Schedule Item Title Retention Inclusive Volume Disposition
No. No. Dates in Action and
Date
Cubic
(Completed After
Feet
Authorization)
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2/614
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. Anydisposed of in the manner and on the date shown in column g.
deletions or modifications are indicated.
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______________________________________ ___________________________________________________________
Clerk’s Office Signature Date Signature of Person Disposing of Records Name/Title Date
Routing:
1.Originates with Department Senior Manager, then1.Originates with Department Senior Manager, then
2.Village Clerk’s Office authorizes disposition and/or storage
2.Village Clerk’s Office authorizes disposition, and returns to
at the storage room and will contact Public Works to remove
3.Originating department to dispose and document column g,
records
then sends
3.Clerk’s Office will be responsible for final disposition of
4.Completed form to Village Clerk’s Office for permanent
records at this point
archival
Form Updated:
OR
Continuation Page
a.b. c. d. e. f.g.
Schedule Item Title Retention Inclusive Volume Disposition
No. No. Dates in Action and
Date
Cubic
Feet (Completed
After
Authorization)
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:03503132
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:03503132
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:03503132
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TOTAL CUBIC FEET THIS PAGE:
/614