HomeMy WebLinkAboutDispositions Forms_07-21_9/3/2021_Clerk NO. 07-21
RECORDS DISPOSITION DOCUMENT 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, MMC
Te uesta, FL 33469 561) 768-0443
3. NOTICE OF INTENTION: The scheduled records listed in Item 5 are to be disposed of in the manner specified
below (specify only one).
Oa. Shred at Department Level O c. Send to Storage until O e. Recycle
Disposition Date Met
Ob. Send to Storage for Shredding O d. Removed from Server Of. Other
4. SUBMITTED BY:
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.
�kz � ���,_1 Lori McWilliams, Village Clerk 02/05/21
Signature Name and Title (Senior Staff only) Date
5. LIST OF RECORD SERIES
item#. p -ecord�cc or"b"for du plrcate.
a. b. c. d. e. f. g.
Schedule Item Title Retention Inclusive Volume Disposition
No. No. Dates in Action and
nsert,a. Cubic Date
or"b" Feet Completed
after item After
#(247b, Authorization
GS1-SL 242a RUO 11/2020-12/2020 .02
TOTAL CI Bib FEET TRtS PAGE:
6. DISPOSAL AUTHORIZATION: Disposal for 7. DISPOSAL CERTIFICATE: The above listed records have been
the above listed records is authorized. Any dispo d f in the manner and on the date shown in column g.
eletions or modifications are indicated.
Ul.�- y �z- ,� E d r► r� a/
Records Liaison Officer Signature Date Signature Na`�e/Ti
./ltle ate
CGS
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: 4/11/18, 1/26/21
OR