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RECORDS DISPOSITION DOCUMENT <br />NO. <br />PAGE OF PAGES <br />1. AGENCY NAME and ADDRESS <br />Indian River County Fire Rescue <br />4225 43rd Avenue <br />Vero Beach, FL 32967 <br />2. AGENCY CONTACT (Name and Telephone Number) <br />Brian Burkeen, Assistant Chief <br />(772) 226 - 3864 Ext. <br />3. <br />NOTICE OF INTENTION: The <br />one). <br />• a. Destruction <br />scheduled <br />• <br />records listed in Item 5 are to be <br />b. Microfilming and Destruction <br />disposed of in the manner checked below (specify only <br />CI c. Other Scanned and Destruction <br />4. SUB <br />the r <br />TTED BY: <br />c rds h <br />I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for <br />ve been fully justified, and that further retention is not required for a litigation pending or imminent. <br />12,c -4,4.,e..1.--) ,bo„U i).P;c1,A ,c(5- StaifAssa. r t -s.1 <br />Sig <br />si <br />ture Name and Title Date G • 8.• /i <br />llZ# <br />_ .. 5. LIST OF RECORD SE E <br />a. <br />Schedule <br />b. <br />Item <br />c. <br />TitleRetention <br />d. <br />e. <br />Inclusive <br />f. <br />Volume <br />In <br />g. <br />Disposition <br />Action and <br />No. <br />No. <br />Dates <br />Cubic <br />Feet <br />Date <br />Completed <br />After <br />Authorization <br />GSI- <br />SL <br />GSI- <br />SL <br />188 <br />23 <br />Patient Refusals <br />Information Record Requests <br />• <br />5 CY <br />1 CY <br />December 2010 thru May <br />2015 <br />April 2015 <br />1.5 <br />2 <br />4 ccvn,,_ <br />p (,L.Laie- <br />c4 <br />r <br />6. DISPOSAL AUTHORIZATION: Disposal for the above listed <br />records is authorized. Any deletions or modifications are indicated. <br />7. o ISPOSAL <br />• spose. of 1. <br />CERTIFICATE: The above listed records have been <br />the manner and on the date shown in column g. <br />1 <br />' " - / , 6 /�Asll <br />Si <br />nature Date <br />! /1 r\ GA h. R) c,in A l of s 3-kff A5,4 Tl <br />Custodian/Records Management Liaison Offi r Date <br />Name and Tale ` <br />s a <br />0 la <br />Witness...ba <br />281 <br />t� <br />II <br />