Box 171
Records Inventory Data Worksheet
PrintForm ... j
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Records Series
Description
~J l~ -( ( ~ Se v~ ~ (
I...~ (.,L.O \i ",1-\Y\
Government Agency 11 \;)w(\ . ..cr\ W
Record Series Title W 1"""\ { ( ~C .,..J e (
Date Span I~,,'t'\vl. \>t. t)
~\)tJ~
(describe content
and characteristics
of records)
{ Alphabetical
{ Numerical
Arrangement 0 Chronological
C Alphanumeric
{ Other (specify) I
C Not Scheduled Retention per;Od!
( Permanent 6 '1~ >1)
Retention
C Historic
. Scheduled Schedule # I ' '~c .11 Schedule L I
.S"m~m\m
Location I L '"' 1l\ yJ ...S'\..,
Format . Paper r Audio-visual ('Micrographic (' Electronic
Total Quantity {Cubic Feet: r Items Amount: I '., Type of Items: I
Annual ('Cubic Feet Amount: I . I I Items I I
Accumulation
Frequency of Use {Daily r Weekly ('Monthly Q Seldom (' Never
Restrictions on Use IN/A I
Records Are: In Poor r Vital (Essential o Official Copies
( Condition to Operations)
Name of Person Completing Record I '~t I". \^ L.. \) ',,"\l~1 ..1 Date I 'i-~' 'I) I
J
New York State ArchIVes
JCM (2011-01-05)
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