RECORDS DISPOSITION DOCUMENT
Send One Copy to: DEO Records Management, 107 E. Madison Street Tallahassee, FL 32399, Fax: (850) 245-7470
| |RECORDS DISPOSITION DOCUMENT |NO. __________________ |
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| | |PAGE 1 OF ___ PAGES |
|AGENCY |2. DIVISION |3. BUREAU |
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|4. ADDRESS (Street, City, and Zip Code) |5. CONTACT (Name and Telephone Number) |
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|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 manner checked below |
|litigation pending or imminent. |(specify only one): |
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|Signature Date |___ a. Destruction ___ b. Microfilming and Destruction |
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|Name and Title (RECORDS CUSTODIAN) |___ c. Other _____________________________________ |
|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 Feet |Completed After |
| | | | | | |Authorization |
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|9. DISPOSAL AUTHORIZATION Disposal for the above listed records is authorized.|10. DISPOSAL CERTIFICATE The above listed records have been disposed of in the manner and|
|Any deletions or modifications are indicated. |on the date shown in column g. |
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| |Signature Date |
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|RMLO Signature | |
|Date |Name and Title |
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| |Witness |
|Supervisor Signature |NOTE: Upon disposition retain this form for your records & send copy to RMLO. |
|Date | |
DEO Form GSR-2 (Rev 06/13/2013)
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