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HomeMy WebLinkAboutDisposition Forms_34-15_04/21/2015_Public Works Revised : 1/22/14 PAGE j OF PAGES 1.AGENCY 2. DEPARTMENT 3. BUREAU Village of Tequesta 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- 768 -0440 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): Only the Depart nt Head has the authority to sign off on Item 6. Signature Date tZ� Name Title 8. LIST OF RECORD SERIES a. b. C. d. e. f. 9. Schedule Item Title Retention Inclusive Volume Disposition Item No. Dates in Action and Date Cubic Completed After Feet Authorization G Vic.. 8 6a� (LEI Peb�s T ��� ��1 ' �3 �e lvo 5 ✓_ c. 5 ;,cam �F `g� '9 63 I oa AWA 3c- M Val `(. ._)GOD, t �—S S� 3�I & &Js" S l C o- Cad- 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 �, foW'� Date J Signatur Date Print Name: Lori McWilliams, MMC Print Nam Print Title: Village Clerk Print Title vy)j n S (+ . NOTE: Upon disposition retain this form for your records Light gray shading indicates a field required to be completed by department. Print Form Light blue requires a signature •' • • �• NO. !� Revised : 1/22/14 PAGE OF PAGES 1.AGENCY 2. DEPARTMENT 3. BUREAU Village of Tequesta � L -1 c 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- 768 -0440 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. I manner checked below (specify only one): Only the Department H X d has the authority to sign off on Item 6. Signature Date 7— Name X Title 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 f C51 -SL 70 (mil LCnn IGI R pug qcs i 2 � 3 L.J- - QCJCAJC � P &S I -Sc q �k Pw cIVAsI VI hco-as 5r M C), 199 3 Grs l 1 q U- (Mlisl � m cx�s�le e a cD Csi 13(( Pry FI BS : I r Ictc� I 19ao ,ca G-5 ' 'G 3 SL- 1qA 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 1 ) ` Signatu ,A /t Date 1S T � � Print Name: Lori McWilliams, MMC J Print Na YYY (C �� Print Title: Village Clerk Print Title S NOTE: Upon disposition retain this form for your records Light gray shading indicates a field required to be completed by department. Print Form Light blue requires a signature REC ORDS • • DOCUMENT NO. J I� Revised : 1/22/14 E Z J eJ E OF L. PAGES 1.AGENCY 2. DEPARTMENT 3. BUREAU Village of Tequesta ('- U 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- 768 -0440 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): Only the Departm t a as the authority to sign off on Item 6. Signature Date hd Name 6,A L Q Title . (f ( dZVve- 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 I f Feet Authorization ui 1 � i�3 �,�lili CuS (cecc ?cts ' ? 4 Imo C' q l �� �� C r) C ,ova t (5 GA c s << �® r I G, 19 L F ' ( 040 LA 4�e o4 �� C S �(� t► tc (� s 1 9q3 3 V T 54 ^ 1_1 v -� i C- ��P�J CCU � �� (�C�n�1, � � ��' Qa a � � � 5 ► L :�- ��J 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) c I Signature (�,� l�" Date { Signature,` �� ���5 Date Print Name: Lori MccW MMC Print Name Print Title: Village Clerk Print Title n ( _ fA S ` NOTE Upon disposition retain this form for your records Light gray shading indicates a field required to be completed by department. Print Form Light blue requires a signature Revised : 1/22/14 PAGE OF PAGES 1. AGENCY 2. DEPARTMENT p�J /(� i , 1 ©/� 3. BUREAU Village of Tequesta / 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- 768 -0440 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): Only the Departm t Head has the authority to sign off on Item 6. Signature - Date Name S /T/� ` /(� j��C Title 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 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 l f�C��l.?�f Date 7 Signat Date d Print Name: Lori McWilliams, MMC Print NartS Print Title: Village Clerk Print Title Ad M (11 A SS ;5* NOTE: Upon disposition retain this form for your records Light gray shading indicates a field required to be completed by department. Print Form Light blue requires a signature