Box 174
Records Inventory Data Worksheet
I.' Prin'tForin.'
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Government Agency t\~W(\ ..~-\ ~ '-'" l
Department 1\1\ L~I1J\JI'l-~I\
Record Series Title
Date Span
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Records Series
Description
(describe content
and characteristics
of records)
""",- //
~/,;-/
(' Alphabetical
(' Numerical
Arrangement G Chronological
C Alphanumeric
(' Other (specify) I
.. .. ..
C Not Scheduled Reten';on perlOdl ~~~~..1 ~ _~\5
C Permanent \0 '~eL.! )
Retention .... ....
C Historic
6 Scheduled Schedule # III~bc\J ; II Schedule I 1.0 't U-\ 'S I
...........------.-,......--..-......,---
Location ICv-\ 'i\ .~ J~
Format . Paper (' Audio-visual CMicrographic r Electronic I
Total Quantity rCubic Feet: (' Items Amount: I ..1 Type of Items: I
Annual (' Cubic Feet Amount: I mllltems I I
Accumulation
Frequency of Use ('Daily (' Weekly CMonthly . Seldom (',Never I
Restrictions on Use IN/A.
... . ..... .. .. .. ... .. .. ...
Records Are: In Poor (' Vital (Essential .,Official Copies
r Condition to Operations)
Name of Person Completing Record I Re..n\ V\'- U ~,v~ .1 Date I 'i .. ~~ - II I
v
New York State Archives
JCM (2011-01-05)
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