HomeMy WebLinkAboutDisposition Forms_22-16_12/28/2016_Police RECORDS DISPOSITION DOCUMENT NO. as " (Le
Revised : 8/3/16 PAGE OF PAGE(S)
1. AGENCY 2. DEPARTMENT Clerk 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 litigation The scheduled records listed in Item 8 are to be disposed of in the
pending or imminent. To be signed by department head only. manner checked below (specify only one):
Signature Date 11/01/2016 0 a. Shred 0 b. Recycle
c. Imaging and Destruction d. Removed from Server
Chief Chistoph lg O Deleted from IT Server
Name and Title e. 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
- GA4-6L 302 Surveillance Records 30 Days 7/1/2016 - 7/31/2016 .25 11/1/2016
(Village Maintains for 90 Days) See Above
TOTAL CUBIC FEET: I L
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 r ecords Disposition)
AWN.
Signature: 6 0� Date: Signature: �'< Date:
Print Name: Lori McWilliams Print Name: , � 1
Print Title: Village Clerk Print Title:
NOTE: Upon disposition retain this form for your records