HomeMy WebLinkAboutDisposition Forms_04-11_04/04/2011 RECORDS DISPOSITION DOCUMENT No. 4 -11
Revised 11/9/07 PAGE OF 1 PAGES
1.AGENCY 2. DEPARTMENT 3. BUREAU
Village of Tequesta Manager N/A
4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number)
345 Tequesta Drive Lori McWilliams, MMC
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
litigptidn pending or 7 ii n manner checked below (specify only one):
1
Signature Date f / �a. Destruction b. Microfilming and Destruction
a.1 Shred El a.2 Recycle
c. Imaging and Destruction
Name and Title v V d. Other
8. LIST OF RECORD SERIES
a. b. C. d. e. f. g.
Schedule Item Title Retention Inclusive Volume Disposition
Item No. Dates in Action and Date
Cubic Completed After
Feet Authorization
124 Operational and statistical Report ROA 2001 - 2004 a 005' 2 Deleted
Records Q006 -4** from
•
Monthly Reports (electronic Computer
GS1 -SL copies)
i q It t pt J `ems ti
9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have been
authorized. Any deletions or modifications are indicated disposed of in the manner and on the date shown in column g.
«�. (Witness to the Records Disposition)
Signature: �(� Date: v Signature: M Date..jJ & /i(
Print Name: Lori McWilliams Print Name: OY ,!(� �(
Print Title: Village Clerk Print Title:
NOTE: Upon disposition retain this form for your records