Box 173
Records Inventory Data Worksheet
I . print'Form.j
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Department I .t\(.,(.':)'v":'-\ ~f\
Government Agency 11'lJ \AlA_ (~, v-J {...
Record Series Title
Date Span
Records Series
Description
(describe content
and characteristics
of records)
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r Alphabetical
C Numerical
Arrangement C Chronological
C Alphanumeric
r Other (specify) I
... .. _
C Not Scheduled ~\J \J c\ ttl d$J "0')
Retention Period S (;~tkh
r Permanent
Retention .... -- ..
C Historic
~ Scheduled Schedule # 1..\~~j5~'~... .......... ~ I Schedule 1?5}~LJ) _ .. .1
Location I
Format f} Paper r Audio-visual ('Micrographic (' Electronic I
Total Quantity ('Cubic Feet: (' Items Amount: I .1 Type of Items: I
Annual C Cu bic Feet Amount: I I I Items I I
Accumulation
Frequency of Use ('Daily r Weekly ('Monthly ~Seldom . "('Never
Restrictions on Use IN/A
. .. . .. ... .
Records Are: In Poor r Vital (Essential ",Official Copies
r Condition to Operations)
Name of Person Completing Record I ~t.~~\^1.... D t\V1-~ ..1 Date I ~ - d--~ ~\\ I
J - -
New York State ArchIVes
JCM (2011 01 05)
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