Box 28
Records Inventory Data Worksheet
See Inslruccions in Publication #76, Inventory and Planning, before compleling lhis form.
la. GOVERNMENT/AGENCY
lb. DEPARTMENTIUNIT
2.
Y'<
II J -
'"
l.<;
3. DATE SPAN
02"
4. RECORDS SERIES DESCRIPTION (Describe content and characlerislics of records)
.-.='-~'~""- ,..,
~\ {? k' <-
J. .' ~~.-- _ -'.
"\ ~ ~ ;\ ~ ,..;t
., t.,,,,
;- C \.l \-', \ "'1,, ,,~
_._~"~\f'-~ - Dee
5. ARRANGEMENT
o Alphabetical
W Numerical
~\.
o Chronological
o Alphanumeric
o Olher (Specify):
6a. RETENTION
o Nm scheduled 0 Permanent 0 Appraise for historical value
~,scheduled retention:
b V Q ~ ~(J , tJ
6b. SCHEDULEAND ITEM NUMBER, ORREASONFORPROPOSEDRETENTION
i l' rO'"" <_\
, ~ . --lL...~ .:> t,'-=..J
7. LOCATION
C a. 12. Il,; W ft'
8. FORMAT
~aper 0 Audiovisual 0 Micrographic 0 Eleclroruc
9. TOTl\L QUl\NTITY (In cubic feel ornumber of items),
~ Cubic feel: L \ 0 Items:
10. ANNUAL ACCUMULATION (In cubic feet arnumber of ilems),
r:fcubiC feel: L \ 0 Items:
11. FREQUENCY OF USE,
o Daily 0 Weekly 0 Monthly ~eldom
12, RES1RICTIONS ON USE
NtY
RECORDS l\RE
13. 0 IN POOR CONDmON
14. 0 VITAL (Essential to operations)
15. ~FF1ClAL COPIES
16a. NAME OF PERSON COMPLETING FORM
~'\. , \ -,~r\
rc
f ..~e (,J't
//.//-~--7
// IV)
*
~.
Type of items:
o Never
16b. DATE
GRS.2 (12/2002)
92.7992592.146 CDC