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RECORDS DISPOSITION DOCUMENT PAGE 1 OF 2 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 Q c. Send to Storage until 0 e. Recycle
Disposition Date Met
b. Send to Storage for Shredding 0 d. Remove from Server 0 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 ve been fully justified, and that further retention is not required for any litigation pending or imminent.
Sign re 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
GS4 70 RUN REPORTS: EMERGENCY 7 AY 2001 1.5 hid
7 � Z
GS4 70 RUN REPORTS: EMERGENCY 7 AY 2009-2010 1.5
GS4 70 RUN REPORTS: EMERGENCY 7 AY 2014 1.5
GS4 70 RUN REPORTS: EMERGENCY 7 AY 2014 1.5
GS4 70 RUN REPORTS: EMERGENCY 7 AY 2014 1.5
TOTAL CUBIC FEET THIS PAGE: 7.
6. DISPOSAL AUTHORIZATION: Disposal for 7. DISPOSAL CERTIFICATE: The above listed records have been
the above listed records is authorized. Any disUUAIK
in the manner and on the date shown in column g.
de etions or modifications are indicated.
J I a3►3L Y 71 � ( 1-3
Clerk's Office Signature Date Signature of Person Disposing of Records Name/Title Date
Routin :
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:9121121
OR
Continuation Page
a.
Schedule
No.
b.
Item
No.
C.
Title
d.
Retention
e.
Inclusive
Dates
f.
Volume
in
Cubic
Feet
g.
Disposition
Action and
Date
(Completed
After
ALthorization
GS4
70
RUN REPORTS: EMERGENCY
7 AY
2014
1.5
Shr 44
114 3
GS4
70
RUN REPORTS: EMERGENCY
7 AY
2014
1.5
I
TOTAL CUBIC FEET THIS PAGE: