HomeMy WebLinkAboutDisposition Forms_20-17_07/07/2017_Utilities RECORDS DISPOSITION DOCUMENT No. ao_in
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1. AGENCY NAME 2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA Number)
Lori McWilliams, MMC
DEPARTMENT: (561) 768-0443 4C
3. NOTICE OF INTENTION: The scheduled records listed in Item 5 are to be disposed of in the manner checked
below (specify only one).
0 a. Shred 0 b. Imaging and Destruction O c. Recycle
Od. Removed from Server 0e. Other
4. SUBMITTED BY:
I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the
recor have been fully justified, and that further retention is not required for any litigation pending or imminent.
Si ature Name and Title ( enior 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
GS1-SL 340 Disbursement - Purchase Orders 5 FY 2005 - 8/2011 1
TOTAL CUBIC FEET THIS PAGE:
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.
dele ns or modifications are indicated. fitness to the records disposition)
rA� �.- I
1 1 I1 Signature Date
Custodian/Records Liaison Officer Date 1 `� r1 e
Name and Title �l
Form Updated: 1/3/17