"Records Disposition Document Form" - Florida

This Florida-specific printable "Records Disposition Document Form" is a part of the legal paperwork issued by the Florida Department of Juvenile Justice.

Download the up-to-date PDF by clicking the link below and mail it as per the guidelines provided by the department.

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Download "Records Disposition Document Form" - Florida

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NO.
RECORDS DISPOSITION DOCUMENT
PAGE
OF
PAGES
1.
AGENCY NAME and ADDRESS
2.
AGENCY CONTACT (Name and Telephone Number)
(
)
-
Ext.
The scheduled records listed in Item 5 are to be disposed of in the manner checked below (specify only
3.
NOTICE OF INTENTION:
one).
a. Destruction
b. Microfilming and Destruction
c. Other
: I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for
4.
SUBMITTED BY
the records have been fully justified, and that further retention is not required for any litigation pending or imminent
.
_____________________________________________________________________________________________________________________
Signature
Name and Title
Date
5.
LIST OF RECORD SERIES
f.
g.
e.
Volume
Disposition
a.
b.
c.
d.
Inclusive
In
Action and Date
Schedule
Item
Title
Retention
Dates
Cubic
Completed After
No.
No.
Feet
Authorization
From M/D/YY To M/D/YY
6.
DISPOSAL AUTHORIZATION: Disposal for the above listed records
7.
DISPOSAL CERTIFICATE: The above listed records have been
is authorized. Any deletions or modifications are indicated.
disposed of in the manner and on the date shown in column g.
___________________________________________________________
Signature
Date
___________________________________________________________
___________________________________________________________
Name and Title
Custodian/Records Management Liaison Officer
Date
___________________________________________________________
Witness
Reset/Clear Form
Save As
NO.
RECORDS DISPOSITION DOCUMENT
PAGE
OF
PAGES
1.
AGENCY NAME and ADDRESS
2.
AGENCY CONTACT (Name and Telephone Number)
(
)
-
Ext.
The scheduled records listed in Item 5 are to be disposed of in the manner checked below (specify only
3.
NOTICE OF INTENTION:
one).
a. Destruction
b. Microfilming and Destruction
c. Other
: I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for
4.
SUBMITTED BY
the records have been fully justified, and that further retention is not required for any litigation pending or imminent
.
_____________________________________________________________________________________________________________________
Signature
Name and Title
Date
5.
LIST OF RECORD SERIES
f.
g.
e.
Volume
Disposition
a.
b.
c.
d.
Inclusive
In
Action and Date
Schedule
Item
Title
Retention
Dates
Cubic
Completed After
No.
No.
Feet
Authorization
From M/D/YY To M/D/YY
6.
DISPOSAL AUTHORIZATION: Disposal for the above listed records
7.
DISPOSAL CERTIFICATE: The above listed records have been
is authorized. Any deletions or modifications are indicated.
disposed of in the manner and on the date shown in column g.
___________________________________________________________
Signature
Date
___________________________________________________________
___________________________________________________________
Name and Title
Custodian/Records Management Liaison Officer
Date
___________________________________________________________
Witness
Reset/Clear Form
Save As
Continuation Page
f.
g.
e.
Volume
Disposition
a.
b.
c.
d.
Inclusive
In
Action and Date
Schedule
Item
Title
Retention
Dates
Cubic
Completed After
No.
No.
Feet
Authorization
From M/D/YY To M/D/YY
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