Box 176
Records Inventory Data Worksheet
I. Print Form . :J
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Government Agency h<lwV\ ..~,,_
Department I&c<{ \)'v01;{)
Record Series Title
I Date Span
I
Records Series
Description
~ h,y,\( S' ~ t ~t"''\ ~
~'-b-h ~~{{\S
(describe content
and characteristics
of records)
r Alphabetical
r Numerical
Arrangement G Chronological
r Alphanumeric
r Other (specify) I
e- Not Scheduled R&ention Period I ~~~~ \-~ ~t\~ 6)-t/...\ ")
r Permanent
Retention
C Historic
. Scheduled Schedule # I\!~\~J II Schedule [k~~~~\) I
I C.b\ 'f\\N ~\""' '" -
Location
Format o Paper (' Audio-visual (' Micrographic (' Electronic I
Total Quantity rCubic Feet: r Items Amount: I '.1 Type of Items: I
Annual ('Cubic Feet Amount: I '1IItems I I
Accumulation
Frequency of Use rDaily 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 \Zt~\Y\L. \) ",'.J L~\ ..1 Date 14 -~~'\\ I
.... - -
New York State ArchIVes
~~;2~.ol 05)
t\U~
