Box 043
". ~~""",,~~:3,~~~,~~~;';;~Z ~:~'~~~~;!~~~C:':J;I"'''fI ,I'" r mm
la, GOVERNMENT/AGENCY lb, DEPARTMENT/UNIT
2. JD~~;;ES~~ \~... U\ V\~t (
~h; \ ~\\ \\-t ~~t t.r
\ C\~ ~
4, RECORDS SERIES DESCRIPTION (Describe conteDe unci characteristics of records)
Ct>1"\\{(
3, DATESPAN
3 It,~ \\) ~ '\)\'{
\~~l
5, ARRANGEMENT
o Alphabetical 0 Numerical
o Ocher (Specify):
6a. RETENTJqN
o NOl scheduled 0 Permanem 0 Appraise for hisconcal value
}(scbeduled retention: S S 'Y { S
6b. SCHEDill..EAND ITEM NUMBER, ORREASONFORPROPOSEDRETENTION
~ Chronological
o Alphanumeric
7, LOCATION
Lh-t'f\'Wl.....\
8, ~RMAT
JlC\Paper 0 Audiovisual 0 Micrographic
9, TOTAL QUT\NTITY (In cubic feel or number of items I'
~UbiC feet: 0 Items:
10. ANNUAL AC CUMULA11 ON (In cubic feet arnumber of items),
o Electronic
Type of icems:
Cubic feet:
o llems:
11 JlREQUENCY OF USE,
o Daily 0 Week]y
12 RESTRICTIONS ON USE
NR
RECORDS ARE
13. 0 IN POOR CONDITION
14,. Q VITAL (EssenriallO operalions)
15, "'f\ OffiClAL COPIES
16a. NAME OF RSON COMPLETING FORM
~ \j1l-NJ' ~
o Monthly
Seldom
o Never
16b. DATE
~~~~..~
GRS.2 (12/2002)
92-7D!J:lS 92-1'16 CDC
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