Box 050
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Records Inventory Data V\for}cshe8t
S8C IrlSLlUCLlDI1S JrI PubllciJllofl '//76, JnVf.'!JLIJJY and PJannin!J, befoJ'r:: cornpleLing [jljS form.
118 GO\!ERNMENT/AGENCY
"\ O\N 1(\ \) "
2, RECORDS SERIES TITLE
9k ~ \\
3, DATE SPAN
lb. DTIPARTMTINT/UNJT
W,,~~\,,') (r C\)""~ 1J'- \\tf
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4. RECORDS SERIES DESCRIPTION (Describe concenc ,md c!Jar8cteristics of records)
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~ '--11''' \\
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5, ARRANGEMENT
o AJphaberical 0 Numerical
o Ocher (Specify)
~ Chronological
o AJphanumenc
6a. RETENTIqN
o NO[ scheduled 0 Permanem
'i Scheduled retention:
o Appraise for hiswrical value
.~Sy~
6b SCHEDlILEAND ITEM NUMBER, ORREASONFDRPROPOSEDRETENTION
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7. LOCATION (~
"--''''-{ Y\ w ,,~ ~ ~
8. FORMAT
"fi. Paper 0 AudIOvisual 0 Micrographic 0 Electronic
9, TOTN- QUl\NITry (In cubic feet ornumber of items),
'){ Cubic feet: 0 Items:
10. ANNUAL ACCUMULATION (In cubic reet or number of items),
~CUbJC feet: 0 Items:
n. .EREQUENCY OF USE,
o Daily 0 Weekly 0 Monthly Seldom
12 RESTRICTIONS ON USE
\'J\l\
RECORDS ARE
13 0 IN POOR CONDITJON
14, 0 VITAL (EssenLial LO operallons)
15 Ji.. OFFlCLAL COPIES
F PERSON COMPLETING FORM
Type of items:
o Never
ens-] (J2I2002)
92-799:2592-146 CDC
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#
0~
16b.
ATE
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