HomeMy WebLinkAboutDisposition Forms_41-15_06/19/2015_Storage Unit •'� '• • �• E NO. 1 —
Revised : 1/22/14 PAGE I OF 3 PAGES
1. AGENCY 2. DEPARTMENT Clerk r 7b f Qpe UA C-t 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 Deparunent Heaa has the authority to sign off on Item 6.
Shred
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 358 DISBURSEMENT RECORDS: DETAIL 5 FY 2002 -2006 1.5
GS1 -SL 340 DISBURSEMENT RECORDS: DETAIL 5FY 2007 -2009 27
GS1 -SL 85 BANK STATEMENTS: RECONCILIATION 5 FY 2005 -2009 6
GS1 -SL 365 RECEIPT /REVENUE RECORDS: DETAIL 5 FY 2007 -2009 3
GS1 -SL 57 Audits: Supporting Documents 3 FY 2009 1.5
GS1 -SL 149 UNEMPLOYMENT COMPENSATION/ 5 FY 1997 -2008 .5
REEMPLOYMENT ASSISTANCE TAX RECORDS
GS1 -SL 368 SALES /USE/LOCAL OPTION TAX RECORDS 5 FY 1997 -2008 .5
GS1 -SL 195 PAYROLL RECORDS: SUPPORTING DOCUMENTS 5 Y 1997 -2008 .5
GS1 -SL 24 EMPLOYMENT APPLICATION AND SELECTION 4 Anniv 1990 -2010 3
RECORDS
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 1 ���-t_ Date � 0 (� Signature l ; Date (121' 5�
Print Name: Lori McWilliams, MMC Print Name I YV�L (` M UPS
Print Title: Village Clerk Print Title l' 1C -eak-
NOTE: Upon disposition retain this form for your records
Light gray shading indicates a field required to be completed by department.
ii
Print Form
Light blue requires a signature
REC ORDS '• • DOCUMENT
Revised : 1/22/14 = PAGE 2 OF 3 PAGES
1. AGENCY 2. DEPARTMENT Clerk _ S �Z `a �n• 3. BUREAU
Village of Tequesta S 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 Department Head has the authority to sign off on Item 5.
Shred
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 122 Admin Records 10 Anniv 1997 -2001 4
GS1 -SL 221 Business Tax Receipts 1 Year 2011 -2012 3
GS1 -SL 265 Crash Receipts (Building) 5 Years 2003 -2008 1.5
GS2 70 Crime Analysis Records ROSA 1999 .001
GS2 109 Uniform Crime Reports ROSA 1997 -1998 .001
GS1 -SL 23 Information Request Records 1 FY 1998 -2000 2
G81 -SL 341 Disbursement Records 10 FY 1996, 2000 -2001, 2003 5
GS1 -SL 286 Permits: Building 10 Anniv 1987 -1995 3
2001 -2002
GS1 -SL 35 Payroll Records: Posted 5 FY 1989 1.5
GS1 -SL 24 Employment Applications & Selection Records 4 Anniv 2002 -2003 1.5
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.
!1 ' �y / (Witness to the Records Disposition)
Signature p r,��t I 1 Date �j d (I Signature n '` mot Date 4 l4 Ir
Alt
Print Name: Lori McWilliams, MMC Print Name
Print Title: Village Clerk Print Title V�
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
•'t '• • �• NO. L11
Revised : 1/22/14 PAGE 3 OF 3 PAGES
1.AGENCY 2. DEPARTMENT Clerk 3. BUREAU
Village of Tequesta — S-1arQS c Unit' 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 Department Head has the authority to sign off on Item 6.
Shred
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 253 Contractor Registration 3 Years 2010 -2011 1.5
GS1 -SL 3 Administrative Support Records (Finance) ROSA 2011 -2012 1.5
GS1 -SL 221 Business Tax Receipts 1 Year 2012 -2013 1.5
G11 - a S 3 Con �'rdr:tv� �Qp,J4 3 y+' aoto -a,�►s 1. S Q��
4 c�l�gll�
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 ( c �!� Date `-� 1 Signature - Date
Print Name: Lori McWilliams, MMC Print Name y ; I rnV-OmS
Print Title: Village Clerk Print Title C' t 6-1k-
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