HomeMy WebLinkAboutDisposition Forms_21-14_07/31/2014_Fire RECORDS DISPOSITION DOCUMENT NO.
Revised 11/9/07 PAGE OF 1 PAGES
1.AGENCY 2. DEPARTMENT 3. BUREAU
Village of Tequesta g N/A
4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number)
345 Tequesta Drive Lori McWilliams, CIVIC
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):
a
Signature Date C� Destruction 0 b. Microfilming and Destruction
` n e1 L 0 c. Imaging and Destruction
Name and Title t' LL] 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
CAS `fir
n o r�5- u 2�CD3 -fl
�s k - 51- viscal L , r, 1 q n - - 168G 7 S
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: `34 14 Signature: (J -� /,� / _ Date: 31 14
C.�w 1 w V ■
Print Name: Lori McWilliams Print Name:
Print Title: Village Clerk Print Title:
NOTE: Upon disposition retain this form for your records
- FCik - iHiQ�
All Points Direct Corp.
ALL P P.O. Box 1768 Stuart, FL 34995
rictail shredding (772) 283 - 4152 ' j
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Thursday, July 31, 2014 On Site Ticket # 26278
Villabe of Tequesta Directions Routine Ittstructioits
Fire Station yLy .15 per lb about 20 boxes then to
357 Tequesta Drive
Tequesta, FL 33496
Old
Contacts
Mary or Deanna (561)'](, S 0 � /yy Speci[illrtstructio[ts
Room Description Container Service Item Qty Actual
Weight Weight 0.00
Time In: Ti me Out: Driver: Quantity: +/-
Service I Comments
Certificate of Destruction
11" NE HEREBY CERTIFY THAT THE DOCUMENTS LISTED ABOVE HAVE BEEN FULLY AND
COMPLETELY DESTROYED ON -SITE BY SHREDDING ON THE DATE SHOWN PER
CUSTOMERS INSTRUCTIONS AND ACCORDING TO FACIA, HIPAA & GLBA REGULATIONS
FOR THE ABOVE MENTIONED
COMPANY.
APMS Operator
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Rudy - PDA 1 Stop 99 Village of Tequesta Page 1