HomeMy WebLinkAboutDispositions Forms_09-22_6/9/2022_Clerk (2)NO.
RECORDS DISPOSITION DOCUMENT 11111 "' "1
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, 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).
0 a. Shred at Department Level c. Send to Storage until e. Recycle
Disposition Date Met
Ub. 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.
Digitally signedLori McWilliam
Lori McWilliams Date: 2022.0609Y15:1630-04'005 Lori McWilliams 06/09/202a
Signature Name and Title (Dept. Head/Senior Staff only) Date
�j 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
Cubic
Date
Feet
(Completed After
Authorization
GS1-SL
65
Contract: Non -capital
5 FY
94,97,99, 01
.01
Recycled
6/9/22
GS1-SL
98
Disciplinary Case File: Employee
5 FY
2010
.01
Recycled
6/9/22
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
dt'e�letior�s
disposed of in the manner and on the date shown in column g.
or modifications are indicated.
jlt,,/,//
V tit (((/tt'Y
Clerk's Office Signature Date
Signature of Person Disposing of Records Name/Title Date
�.,�.�
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Originates with Department Senior Manager, then 1. Originates with Department Senior Manager, then
Village Clerk's Office authorizes disposition, and returns to 12. Village Clerk's Office authorizes disposition and/or storage
Originating department to dispose and document colt, at the storage roam and will contact Public Works to remov
then
sends records/
Completed form to V�tlage Clerks Oil+t 3. Clerk's Office will be responsible for final disposition
archival % records at this point
�, �.
Form Updated 9121/21
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