Box 175
Records Inventory Data Worksheet
Print Form I
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Government Agency 1-\ I,) W "" ~\, y..J t-.f {)', ^ h. \ (' Department Iii ~Lt:)'v""'~'^~
Record Series Title I "\ " ~<.. S ~<.(\ ')
I Date Span
Records Series
Description
I '~~\J<6
~\'J \J ~ \ \YV\\ S~t(\~
(describe content
and characteristics
of records)
r Alphabetical
r Numerical
Arrangement . Chronological
r Alphanumeric
r Other (specify) I
r Not Scheduled Retention per;Od! ~'lI1,
r Permanent \\) ~\J \ S
Retention
r Historic
0 Scheduled Sched ule # I S\~\.\(~ II Schedule I bye!.\) I
Location l0--l '" W ;..\\....
Format .Paper (' Audio-visual (' Micrographic (' Electronic
Total Quantity (' Cubic Feet: r Items Amount: I Type of Items: I
Annual r Cubic Feet Amount: I 'I Items I
Accumulation
Frequency of Use r Daily r Weekly (' Monthly . Seldom (' Never
Restrictions on Use I \JIA I
Records Are: In Poor (' Vital (Essential e Official Copies
r Condition to Operations)
Name of Person Completing Record I ~ t.i..\ V\ '- \) '^ \)~' I Date I t-t- ~~ - \\ I
J - -
New York State Archives
JCM (2011 01 05)
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