Box 27
Records Inventory Data Worksheet
See IOstruCClons in Publication #76, lnvenwry and Planning, before completing this form,
la. GOVERNMENT/AGENCY
lb. DEPARTMENT/UNIT
-<'o~ 1\ 6
2. RECORDS SERIES TITLE
~
S ~~
~60~
3. Dl\ 1'8 SPAN
L(
~fXJ ~
4. RECORDS SERlES DESCRIPTION (Describe content and characteristics of records)
\)A \D
,~ ILL,
Sl"'V 6s
~"" ..,. it
,-:). ..... ~,. J
!OO...... r /./.('"
- / S)
( (0
""., J. ~ ......
{'.' ",~' Iot...
[, \. '. ',. 1/' .,.:>
'~""_~' V r--.
5, ARRANGEMENT N..l,
o Alphabetical ~umerical
o Chronological
o Alphanumeric
o Other (Specify):
6a. RETENTION
o Nm scheduled 0 Permanent 0 Appraise for historical value
~scheduled retention:
~i 'IRS :20 III
6b. SCHEDULEJ\ND ITEM NUMBER. QRREASONPQRFROPOSEDRETENTION
I); r ,",Cfp-r
u "' . 1-,=~.:,--~
/........
it):
t,,)
\ \
""" ..;
7. LOCATION
/"\ .{ h
C__ C\ y "c."V 0.-'..'
8. ;&:T
. ,raper o Audiovisual o Micrographic o Electronic
9. TOTAL QUANTITY (In cubic feet ornumber of items).
r:/J Cubic feet: L\ o Items: Type of items:
10. ANNUAL ACCUMULATION (In cubic feet or number of items),
~ Cubic feet: LI o Items:
11. FREQUENCY OF USE,
o Daily o Weekly o Monthly Seldom o Never
12. RES1RICTIONS ON USE
./
rJ1A
RECORDS ARE
13. 0 IN POOR CONDmON
14. ~O VITAL (Essential to operations)
15. OFFICIAL COPIES
i "
16a. NAME OF PERSON COMPLETING FORM
1""'" ~
c. .)
16b. DATE
d !1
'.' "..
k ....J
GRS.2 (1212002)
92.7992592.146 CDC