RECORDS DISPOSITION REQUEST STATE OF FLORIDA DEPARTMENT OF STATE NO. __________________ Division of Library and Information Services PAGE 1 OF _____ PAGES Form LS5E107R4-93 Form Revision: 10/12/05 1. AGENCY 2. DIVISION/COLLEGE 3. DEPARTMENT University of South Florida 4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name, Campus Address, Phone Number) 4202 E Fowler Ave SVC 1073 Tampa, Florida 33620 SUBMIT TO: 6. SUBMITTED BY: I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the records have been fully George Cotter justified, and that further retention is not required for any litigation pending or Director, Procurement Services imminent. University of South Florida 4202 E Fowler Ave , SVC 1073 Signature Date Tampa, Florida 33620-9000 Name and Title 7. UNIVERSITY LEVEL APPROVAL 8. NOTICE OF INTENTION (FOR PURCHASING USE ONLY) The scheduled records listed in Item 9 are to be disposed of in the manner checked below (specify only one): ___ a. Destruction (burned, dumpster, recycle, shredded, etc.) ________________________________________ ___ b. Microfilming and Destruction Irene Orefice Fiscal & Business Assistant ___ c. Other _____________________________________ 9. LIST OF RECORD SERIES (DEPARTMENT MUST COMPLETE ALL CATEGORIES LISTED BELOW) Schedule Item Title as indicated on Schedule Page Number Retention Inclusive Volume in Used No. Period Dates by Cubic Feet Required Fiscal Year * NOTE: FOR CONTINUATION USE Form LS5E108 * 10. DISPOSAL AUTHORIZATION (FOR UNIVERSITY LEVEL ONLY) 11. DISPOSAL CERTIFICATE: The above listed records have been disposed of in Disposal for the above listed records is authorized. Any deletions or the manner and on the date shown above. modifications are indicated. Signature Date UNIVERSITY OF SOUTH FLORIDA Name and Title George Cotter Witness Director, Procurement Services NOTE: Upon disposition return this form to Irene Orefice SVC 1073 and retain Date a copy for your records.
STATE OF FLORIDA DEPARTMENT OF STATE Division of Library and Information Services Form LS5E107R4-93 Form Revision: 10/12/05 RECORDS DISPOSITION REQUEST NO. __________________ PAGE 1 OF _____ PAGES 1. AGENCY University of South Florida 2. DIVISION/COLLEGE 3. DEPARTMENT 4. ADDRESS (Street, City, and Zip Code) 4202 E Fowler Ave SVC 1073 Tampa, Florida 33620 5. CONTACT (Name, Campus Address, Phone Number) SUBMIT TO: George Cotter Director, Procurement Services University of South Florida 4202 E Fowler Ave , SVC 1073 Tampa, Florida 33620-9000 6. SUBMITTED BY: I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the records have been fully justified, and that further retention is not required for any litigation pending or imminent. Signature Date Name and Title 7. UNIVERSITY LEVEL APPROVAL (FOR PURCHASING USE ONLY) ________________________________________ Irene Orefice Fiscal & Business Assistant 8. NOTICE OF INTENTION The scheduled records listed in Item 9 are to be disposed of in the manner checked below (specify only one): ___ a. Destruction (burned, dumpster, recycle, shredded, etc.) ___ b. Microfilming and Destruction ___ c. Other _____________________________________ 9. LIST OF RECORD SERIES (DEPARTMENT MUST COMPLETE ALL CATEGORIES LISTED BELOW) Schedule Used Item No. Title as indicated on Schedule Page Number Retention Period Required Inclusive Dates by Fiscal Year Volume in Cubic Feet * NOTE: FOR CONTINUATION USE Form LS5E108 * 10. DISPOSAL AUTHORIZATION (FOR UNIVERSITY LEVEL ONLY) Disposal for the above listed records is authorized. Any deletions or modifications are indicated. UNIVERSITY OF SOUTH FLORIDA George Cotter Director, Procurement Services Date 11. DISPOSAL CERTIFICATE: The above listed records have been disposed of in the manner and on the date shown above. Signature Date Name and Title Witness NOTE: Upon disposition return this form to Irene Orefice SVC 1073 and retain a copy for your records.
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