Box 076
N
Records Inventory Data V,T orkshe8t
See JrlslJ'ucLioJ1s in Publicmion '1176, ]nVf:IJLDlY and P}annins;, before cornpl~(ing lhis r onn
la. GOVER}JMENT/AGENCY lb. DEPARTMENT/UNIT
2 RE~~~';;'S ~~ \;) f- ~ ~\,) C ( c.u",",~ 1 J'o \ \ tr
1: \ ~-<. \)~f S\{-\.\ -e j 1
3. DATESPAN
'\ <\~ ~ t '0 ~t \)\J
4. RECORDS SERIES DESCRIPTION (Describe content and characteristicS of records)
~ky~\\ \\""'-__ ~~-t S\~~h(~bS{v,S~~
~kl\\)\\ LeI \~\~L~-\'>'0.
5. ARRANGEMENT
o Alphabetical 0 Numerical
o Other (Specify):
6a. RETENTIqN
o NOl scheduled 0 Permanem
~ Scheduled retention:
~chronOJOgiCal
~\\S~
o AJpbanumeric
o Appraise for hismrical value
6b. SCHEDULE AND ITEM NUMBER, OR REAS ON .PORPROP 0 SED RETENTION
8. FORMAT
jiJ.Paper 0 Audiovisual 0 Micrographic 0 Eleworuc
g. TOTAL QUANTITY (In cubic feel or number of iwms),
~ Cubic feet: 0 Items:
10. ANNUAL ACCUMULATION (In cubic feet arnumber of items}
~CUbiC feet: 0 hems:
11. .TIREQUENCY OF USE,
o Daily 0 Weekly 0 Monthly Seldom
12 RESTRICTIONS ON USE
\N\~
RECORDS ARE
13 0 IN POOR CONDITlON
14. 0 VITAL (EssentiallO operations)
15. JS( OFFJCiAL COPIES
16a NAJ F PERSON COMPLETING FORM
7. LOCATION (~
\.--,,-< Y'\ W,,~ \
Type of items:
o Never
16b. DATE
'-l '. li \ D t
03Dy1
~f
CH.S.2 (1212002)
92,799:1592.,"6 CDC