Box 17
Records Inventory Data Worksheet
See JrISlrucuons in F'ulJlicrJlion 1/76, }nVenLDlY and Planning, before completing tillS forrn.
la. GOVERNMENT/AGENCY
.--- -
( 1,'1 '.' I. i. 1- . ~i [/ 'j},) C-I~),=-
2, RECORDS SERIES TITLE
lb. DEPARTMENJiUNIT
c.), , I:
-, I., /'___
'11\1(
. - '
t,> ,"', !~ i" \ I) I I I
3. DATESPAN
,AC( .)
4. RECORDS SERillS DESCRIPTION (Describe content and characteristics of records)
I,t , I " 1.- i i I I f , 1\ (I; I ) / t
I' , I l- ! , ( -
)L /.. , L I) L )< l 1'- , , fl )L C \ , ('
\ I : I I 'f\.
, i J-,I \, ~
5. ~GEMENT
W'J\.JphabeticaJ 0 Numerical
o Other (Specify):
6a. REfENTION
BNm scheduled 0 Permanent
o Chronological
o Alphanumeric
o Appraise for historical value
o Scheduled retention:
{ , ' t t I - I l <_', I "if (.' I .... 41
, . J i '-'-. i 'I ..-, I'-~ ",(-,- /'/' ),' I '\ I, I ; , 'I \ I
6b. SCHEDULE AND l'T'EM NUMBER, ORREASON.FORFRGPOSEDRETENTION
, ; I
J ;
7. LOCA nON
i, t ~ J
8. FO~T
r;rPaper 0 Audiovisual 0 Micrographic
9. TOTAL QUANITfY [In cubic feet or number of items),
o Electronic
Q Cubic r eet:
Type of items:
o Items:
10. ANNUAL ACCUMULATION (In cubic feet arnumber of items),
~C;lbjc feet:
11. EREQUENCY OF USE,
o Daily 0 Weekly
12. RESTRICTIONS ON USE
o Items:
OSeldorn
o Never
o Monthly
,,'I )
" '~
RECORDS l\RE
13. 0 IN POOR CONDmON
14. cYVITAL (Essential La operations)
15. 0 OFFIClAL COPIES
16a. NAME OF PERSON COMPLETING FORM
16b. DATE
New York State IIrchives
GRS2 (12/2002)
92-79925 9;!-Iq6 CDC