Box 081
~
Records Inventory Data V\f orkshe8t
SC::8 If!SlJUCliOIlS if! Publicmion '1176, JnVf:IJ[wy aud Planning bd 01'8 cornplc::[ing LiJIS foml.
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2, RECORDS SERlE{'T~
Wk~G\'^~C(
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lb DEPARTMIlNT/UNJT
c.\)",~ 1 J"\\L(
la GOVERNMENT/AGENCY
3, DATESPAN
4, RECORDS SERIES DESCFUPTJON (Describe coment eWe! CIJal'ClCLerisLics of rBcords)
~ L,~J " \1
~~~
5, llRi\ANGEMENT
o Alphabe[ical D Numencal
o Other (Specify}
6a. RETENTION
,
D Nm scheduled D Permanent D AppraJse for hiswfJcal value
~ S,bed"'ed ,,"mice S:; \.; ( ')
5b. SCHEDULE AND ITEM NUMBER, OR REASON },~R DPoSEDRL'TENTIO'
~ChrOnOJ09ICal
D Alphanumeric
7,
8. FORMAT
~ Paper 0 Audiovisual 0 Micrographic D EleCtronic
g, TOTlIL QUANTITY (In cubic feel ornumber of iLCmsJ,
.){ Cubic feet: 0 Items:
10. ANNUAL ACCUMULATION (In cubic reeL or number of i[ems),
~CUbiC feeL 0 lLems:
11 J1REQUENCY OF USE,
D Daily 0 Weekly 0 Momhly Seldom
]2, RESTRiCTIONS ON USE
Type of ilems
o Never
'N\t\
RECORDS ARE
13, D IN POOR CONDITJON
14, D VITAL (Essemial LO operaLions)
15, ;i., OFFlCLAL COPIES
16a NAJ F PERSON COMPLETING FORM
~ , DWvv 1\
16b. DATE
V'Y"o
ux
.
~J;~;;j\';'~~1;11t 1 s