Box 166
Records Inventory Data Worksheet
Print Form.
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
I Government Agency 110wn ot \\!a..pPlnge.r
, I Department
I Ac.c.()unti ns
Record Series Title I Gene-ro." UisbLlr$ernenf 2008 ...
. .. .. .. ..
Date Span I g-ul y3, 2 0 os to . AugUG-t)b ,200g
... ..... ..... ... . .. .. ..
Records Series 'B i Its 'Det;ky 2 0 P-t
Description
(describe content eoXl~
and characteristics
of records)
..... ...... ... .. ..... .. .... ... ... ...... .. .
(' Alphabetical
(' Numerical
Arrangement . Chronological
C Alphanumeric
(' Other (specify) I
C Not Scheduled Retent;on pe';Odl
(' Permanent
Retention
C Historic
. Scheduled Schedule # I 215 .11 Schedule IMUI I
..,.................--.---..-".
Location I Ca.rn\.U~~
Format .Paper r Audio-visual rMicrographic r Electronic I
Total Quantity .Cubic Feet: r Items Amount: 1.( I ' I Type of Items: I
Annual .Cubic Feet Amount: I .(1 Illtems I I
Accumulation
Frequency of Use (' Daily r Weekly CMonthly . Seldom IICNever
Restrictions on Use IN/A.
.. .. ..
Records Are: In Poor r Vital (Essential . Official Copies
r Condition to Operations)
Name of Person Completing Record I Churl eS "'Reo, YI harcU- .1 Date I A p.-ti , , lOll I
New York State Archives ~~~~~ JCM (2011-01-05)