HomeMy WebLinkAboutDispositions Forms_23-09_11/19/2009 RECORDS DISPOSITION DOCUMENT NO~ ~ o
Revised 11/9/07 PAGE OF 1 PAGES
1. AGENCY
Village of Tequesta 2. DEPARTMENT 3. BUREAU
N/A
4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number)
345 Tequesta Drive Lori McWilliams, CMC
Tequesta, FL 33469 561-575-6200 ext. 244
6. SUBMITTED BY: I hereby certify that the records to be disposed of are 7. NOTICE OF INTENTION
correctly represented below, that any audit requirements for the records
have been fully justified, and that further retention is not required for any The scheduled records listed in Item 8 are to be disposed of in the
litigation pending or imminent. manner checked below (specify only one):
Signature Date ~a. Destruction 0 b. Microfilming and Destruction
~,~ ~ q~9~ ~
C ~ a.1 Shred 0 a.2 Recycle
/V • 0 c. Imaging and Destruction
Name and Title L~+ri/, 0~ ~y~l~ 0 d. Other
8. LIST OF RECORD SERIES
a.
Schedule
Item b.
Item
No. c.
Title d.
Retention e.
Inclusive
Dates f.
Volume
in g.
Disposition
Action and Date
Cubic
Feet Completed After
Authorization
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9. DISPOSAL AUTHORIZATION: Disposal for the above listed records
authorized. Any deletions or modifications are indicated 10. DISPOSAL CERTIFICATE The above listed records have been
disposed of in the manner and on the date shown in column g.
(Witness to the Records Disposition)
Signature: ~ ~ ~ lt~'~~ Date: a' ~ O ~ ~ T Signature: ~' ._ ~ ~-~ Date:l (? 1/1 IG
Print Name: Lori McWilliams Print Name:
Print Title: Village Clerk Print Title: ,,
NOTE: Upon disposition retain this form for your records