HomeMy WebLinkAboutDispositions Forms_21-23_7/6/2023_FireNo. 4q/_9 3PAGE
RECORDS DISPOSITION DOCUMENT
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 0 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
recorVsve been fully justified, and that further retention is not required for any litigation pending or imminent.
.u- - �1 me . !3. u f n C /� f I i 20,.3
Sig 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
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 foF7.DISPOSAL
CERTIFICATE: The above listed records have been
the above listed records is authorized. Aned
of in the ner and on the date shown in column g.
de etions or modifications are indicated.
Ila3la3
GG4---, 1 Z3
C rk's Office Signature Date
Signature of Person Disposing of Records Nam /Tit e 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
�. Completed form to Village Clerk's Office for permanent
records
3. Clerk's Office will be responsible for final disposition of
archival
records at this point
Form Updated: 9/21121
I OR
v
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
Authorization)
GS4
70
RUN REPORTS: EMERGENCY
7 AY
2014
1.5
Ihff�
GS4
70
RUN REPORTS: EMERGENCY
7 AY
2014
1.5
TOTAL CUBIC FEET THIS PAGE: