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HomeMy WebLinkAboutDisposition Forms_59-15_09/20/2016_Police NO. 49--15 5� f- Revised : 1/22/14 PAGE OF PAGES 1.AGENCY 2.DEPARTMENT Police 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 Depa .4et Head as the authority to sign off on Item 6. Recycle Signature Date ©i 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 302 Surveillance Records 30 days 12/1/2014- 12/31/2014 .25 Deleted from IT NOTE: Village maintains for 90 days per council Server 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10.DISPOSAL CERTIFICATE The above listed records have been authorized.Any eletions or modifications are indicated disposed of in the manner and on the date shown in column g. (Witness to the Records Disposition) Signature Date I��J (o Signature Date Print Name: Lori McWilliams,MMC Print Name Print Title: Village Clerk Print Title - L / ika'.4 NOTE: Upon disposition retain this foIrm for your records Light gray shading indicates a field required to be completed by department. Print Form Light blue requires a signature