Box 095
~t.,
Records Inventory Data v,r orksheet
See instructions ill Public81io/l 1:76, inventorl' and Pianmny, before completillfj dlls form.
la, GOVERNMENT/AGENCY
lb, DEPARTMBNTIUNIT
3, DATESPAN
2007
4. RECORDS SERlES DESCRIPTION (Describe comem aJ lcJ cl Jaractenstics of records)
C. hecK 'lY,sbursel'Y'len f:s
Oij23}01- 03}2'6/0'7 2007
(jD IV
5. ARRANGEMENT
o Alphabetical 0 Numerical
)(thronologicaJ
o Alphanumeric
:J Other (Specify):
6a RE'IENTlON
o Not scheduled !J Permanent !J Appraise for historical value
)(Scheduled retention: (;;; years
6b, SCHEDULE AND ITBMNUMBER, ORREASONFORPROPOSED RET.ENTION
1145J
7. LOCATION
La v n o.J(~.A"h
B. FORMAT
)(paper 0 Audiovisual 0 Micrographic 0 Electronic
9. TOTAL QU.ANTITY (In cubic feel or number of items):
.)l(tubiC feel: <:: 0 Items:
10. ANNUAL ACCUMULATION (In cubic feet or number of ilems):
)(CubiC feel: <. I 0 Items:
:ll FREQlJEN'"CYOFUSE:
[] Daily 0 VVeekly 0 Monthly )(Seldom
12. RESTRICTIONS ON USE
Type of items:
:J Never
N~
RECORDS ARE
13. [] IN POOR CONDmON
14. 0 VITAL (Essential to operations)
15. )(OFFICIAL COPIES
16a NAME OF PERSON COMPLETING FORM
16b. DATE
New York State Ilrchiv GRS-2 (12.'2002)
92-799:!5 92.146 COC
, Ii oq