HomeMy WebLinkAboutDisposition Forms_19-15_06/23/2015_Police • ' ' • • • NO. 19 -15
Revised : 1/22/14 PAGE I OF a PAGES
1. AGENCY 2. DEPARTMENT Police 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):
rely the Dep rt ent He yd has the authority sign off on It m 6.
Recycle
Signature Date
Name
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
GS1 -SL 302 Surveillance Records 30 days 7/1/2015 - 7/31/2015 .25 Deleted from IT
NOTE: Village maintains for 90 days per council Server
9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have been
authorized. Any deletions modifications re ind' ated disposed of in the manner and on the date shown in column g.
/ r j � (Witness to the Records Disposition)
Signature / Date ' I_ I 1 Signature - Date O
Print Name: Lori McWilliams, M�MC Print Name
Print Title: Village Clerk Print Title
NOTE: Upon disposition retain this f 4m for vour records
Light gray shading indicates a field required to be completed by depaitlrlent.
Print Form
Light blue requires a signature
• ' ' • • • NO. 19 -15
Revised: 1/22/14 PAGE ,=)- OF ;�-- -PAGES
1. AGENCY 2. DEPARTMENT Police 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 pendin or imminent. manner checked below (specify only one):
Only the Dep nt Head as the authority to sign off on Ite 6.
Recycle
Signature Date CI� 1 t
Name
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
GS1 -SL 302 Surveillance Records C •e 30 days 6/1/2015 - 6/30/2015 .25 Deleted from IT
NOTE: Village maintains for 90 days per council Server
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.
m �J (Witness to the Records Disposition)
Signature Y11�/]�C Date / h �� �^ Signature Date
10 �
Print Name: Lori McWilliams, MMC Print Name f� s
Print Title: Village Clerk Print Title /
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