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HomeMy WebLinkAboutDispositions Forms_05-23_6/8/2023_UtilitiesNO. RECORDS DISPOSITION DOCUMENT PAGE j OF 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). © a. Shred at Department Level © c. Send to Storage until Q e. Recycle Disposition Date Met © b. Send to Storage for Shredding 0 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. a3; Marjorie Craig, Utilities Director 03/24/202J Si ur 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 Cubic Date Feet (Completed After Authorization GS1-SL 167 Environmental Regulation Compliance 5FY 2001 K` MC-ted Records 2004 .01 (vr$(y3 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. eletions or modifications are indicated. nr,4p--,- 4 41 23 Clerk's Office Signature Date Signature of Person Disposing of Records Name/Title Date ¢_ RQutin ' 1 Ongmates wtth Department Senor Manager, then 'sue 1 Ongrnates Department Senior Maneg,Ythen 2 V lage Gld _ atitltonzes disposdion,:I retums to. 3. Ongi�A,���ri# dispose 2 Vllage Clerk's O ise authorzes r�s Stu aerj� Qr storage';, at the to and document column g,• storae room and witl contact phi to,r`emove then sefids 4. Completer) form to• Village Clerk's Office for permanent records = 3 Clerk's Office wlll be responsible for• final l�sposition of arc itt�ral .d. �.•.. records at this,point Form Updatetl.9121121 OR