Box 057
,,~
Records Inventory Data V\!orkshe8t
See JriSlJUCLiDI1S in PubliCiJlJon '1/76, )nvemwy and PJann)ni!, before cornpleung chis forrn
la, GOVERNMENT/AGENCY
lb DEPARTMENT/UNIT
c.\\",,~ 1 J'- \ \l(
2. RE"J~;,,;,~S T~~ \,0h~ ~\,,~ ( r ,
\( ~ \ ~ y-( vv-.. ~ ~ '{( ~ \) 1 S
3, DATE SPAN
\~<i~ r~ '\--\0 \)~
4, RECORDS SERIES DESCRIPTION (Describe conWnl imd cbal'8clerislics of records)
~~ \ ~l\ 'rAi\. '^" tt~" \ ~ ~
\l\ ~(\ \t> ~~t'-I
I 5, ARRANGEMENT
I 0 Aipbabe[ical 0 Numerical
~ChrOnOJ09iCal
o AJpbanumenc
o Other (Specify)
6a. RETENTlqN
o Not scheduled 0 Permanem
~ Scheduled retention:
o Appraise for hiswrical value
S 'S ~\ '-,
6b SCHEDULE.AND ITEM NUMBER, ORREASON .FORPRDPOSED RETENTION
~'-\S
7, LOCATION f~
,--,k-{ Y'\ W ,,~ ~ ~
8. FORMAT
"APaper 0 AudlOvisual 0 MIcrographic 0 EleClronic
9, TOTAL QUl\N11TY (In cubic feel ornumber of ieems},
,){ Cubic feel: 0 hems:
10 ANNUAL ACCUMULA110N (In cubic feel arnumber of items),
~CUbiC feel: 0 hems:
11 .EREQUENCY OF USE,
o Daily 0 Weekly 0 Momhly Seldom
12 RESTRICTIONS ON USE
\N\"
RECORDS ARE
13, 0 IN POOR CONDITlON
14, 0 VITAL (Essential lO opera lions)
15, ;;i.. OFFlClAL COPIES
16a. NAl F PERSON COJvfPLETlNG FORM
Type of ilems:
o Never
16b. DATE
L ~ '. ,b ~
(joy
GTZS-2 (12/2002) # a / -
92-79D:lS 92-lq6 CDC {