Box 172
Records Inventory Data Worksheet
I' Print\Form.; J
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Government Agency L\Q\r.J('.. , "~~
Record Series Title
Date Span
Records Series
Description
(describe content
and characteristics
of records)
<(tv,) ( ~~
Department Lf\c:...(.,Q\lAl.\1\
-<<- \ 10 ,,~\;
~ \) ( ~1-SJ \'J c: \ J,- " h,3\; r'\ (
~\)\'J \
(' Alphabetical
(' Numerical
Arrangement ., Chronological
(' Alphanumeric
r Other (specify) I
(' Not Scheduled Retention Period I
Permanent Ss "tt-"'- I '') ~~\J~ t\':) ~(j "o:J
Retention
C Historic
. Scheduled Schedule # I \..??'j5'm~ , "'" ill Schedule I ? ,~~~I.Jr) I
Location I C"l f\ \AI ""~
.... ............,........
Format .Paper (' Audio-visual (',Micrographic (' Electronic
Total Quantity ('Cubic Feet: (' Items Amount: I ., Type of Items: I
Annual ('Cubic Feet Amount: I I I Items I I
Accumulation
Frequency of Use ('Daily (' Weekly ('Monthly . Seldom (',Never
Restrictions on Use IN/A
Records Are: In Poor r Vital (Essential o Official Copies
(' Condition to Operations)
Name of Person Completing Record I Re.. ~\ '" ~ \j ~....\ll.,,,\, ',.1 Date I ~ - ~~ .. \\ 'j
N York ves J - 1-0
ew
State Archl
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