HomeMy WebLinkAboutDisposition Forms_15-17_05/12/2017_Utilities RECORDS DISPOSITION DOCUMENT
PAGE 1 OF PAGES
1. AGENCY NAME 2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA Number)
Lori McWilliams, MMC
DEPARTMENT: UTILITIES - PUMPING & STORAGE (561) 768 -0443
3. NOTICE OF INTENTION: The scheduled records listed in Item 5 are to be disposed of in the manner checked
below (specify only one).
O a. Shred 0b. Imaging and Destruction 0c. Recycle
0 d. Removed from Server 0e. Other
4. SU MITTED BY:
I here certify that the records to be disposed of are correctly represented below, that any audit requirements for the
ave een fully justified, and that further retention is not required for any litigation pending or imminent.
v T1 U(7r/ rf5 6/v i - �p
Sig a ure Name and Title (Senior Staff only) Date
5. LIST OF RECORD SERIES
6.
a. b. C. d. e. f. g.
Schedule Item Title Retention Inclusive Volume Disposition
No. No. Dates in Action and
Cubic Date
Feet Completed
After
Authorization
L GS1 -SL 54 VISITOR /ENTRY LOG 30 DAYS 1 -2 -15 - 3 -13 -17 1 1
TOTAL CUBIC FEET THIS PAGE: 1
7. DISPOSAL AUTHORIZATION: Disposal for 8. DISPOSAL CERTIFICATE: The above and below listed records have
the above listed records is authorized. Any been disposed of in the manner and on the date shown in column g.
deletions or modifications are indicated. (W'tness to the records disposition)
4ltiG�ec�'� i z s l y �l 1 �
Signature Date
Custodian /Records Liaison Officer Date u kk
Name and Title �
Form Updated: 1/3/17