Box 067
~
Records Inventory Data V\lorksheet
See JrlsCIUCLiollS in Publicauon '1176, JnVefJlD.rv and Plannjng, before cornplc;LIf1g chis lorm
lEI. GOVERNMENT/AGENCY
2 RB~~~~ST~: \;)~~~\,)((
~ \l \Z(L,>j~)
lb. DEPARTMENT/UNIT
c.u ""~ 1 f" \ \ tf
3. DATESPAN
\C\ \~
4. RECORDS SERIES DESCRIPTION (Describe contem clOd characteristics of records)
QlK \(U0J~)
5, ARRANGEMENT
I 0 Alphabetical 0 Numerical
~ChrOnOJOgiCal
o Other (Specify):
6a. RETENflqN
o NO[ scheduled 0 Permanem
~scheduled retention:
o AJphanumeric
o Appraise for historical value
SS lIS
6b SCHEDULE AND ITEM NUMBER, ORREASON.FOR.P.ROPOSEDRETENTION
7. LOCATION ('
"--'h-~ '" W I...i ~ \
8. FORMAT
"ji.raper 0 Audwvisual 0 MIcrographic 0 Eleccronic
9. TOTAL QUANTITY (In cubic feel oJnumber of iwms),
'){ Cubic feel: 0 hems:
10, ANNUAL ACCUMULATION (In cubic feet [JJ' number of items),
~CUbiC feet: 0 hems:
1] .F.REQUENCY OPUSE,
o Daily 0 Weekly 0 Monthly Seldom
12 RESTRICTIONS ON USE
\N\"
RECORDS ARE
13, 0 IN POOR CONDITJON
14, 0 VITAL (Essential to opera lions)
15, 'f/.. OFFlClAL COPIES
16a. NAJ
Type of items:
o Never
16b. DATE
L),. ~'".o 3
~ 0 'ilt
/J~
GRS-2 (J2J2002)
92.7991.592-\'16 cae