HomeMy WebLinkAboutDisposition Forms_21-17_06/23/2017_Utilities RECORDS DISPOSITION DOCUMENT NO Q 1 —0
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1. AGENCY NAME 2. AGENCY CONTACT(Name and Telephone
VILLAGE OF TEQUESTA Number)
Lori McWilliams, MMC .
DEPARTMENT: 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).
0a. Shred Ob. Imaging and Destruction c. Recycle
0d. Removed from Server 0e. Other
4. SUBMITTE BY:
I hereby certif at the records to be disposed of are correctly represented below, that any audit requirements for the
records have en fully justified, and that further retention is not required for any litigation pending or imminent.
Signature Name and Title (Senior tall only) Date
5. LIST OF RECORD SERIES
6.
a. b. C. d. e. f. 9-
Schedule Item Title Retention Inclusive Volume Disposition
No. No. Dates in Action and
Cubic Date
Feet Completed
2 t After
Authorization
GS1—SL 340 Disbursement: 5 FY 10-2-09 — 9-29-11
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.
deletions or modifications are indicated. itness to the records disposition)
YAft�m nj'� Tnature Date
Custodian/Record Liaison Officer D to Oyt- �r lGf�✓c I��A��
Name and Title
Form Updated: 1/3/17