Box 177
Records Inventory Data Worksheet
PrintForm . . ;,
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Government Agency I '1UWY'tJ\.. \rJ '-'...~ P\f\L..tC Department I A('l.:Q'v,,",'<~ '1\,
Record Series Title 1~9Y\.~ ....~J .'(\~]C . \v'\~~\'fV\L.,1'~,\~J\ '..-
I Date Span
Records Series
Description
Im'Q-.~',)\)\,.. ..~m ~~\~'J m
60~,\,:> ~\ \~\)'i\~ N ~ \, \
~ ~ \)l.\I ~\~".\\ "'"
C- ,,~~ ~ ~' ~ l ';)j~t \ ~
I
(describe content
and characteristics
of records)
(' Alphabetical
C Numerical
Arrangement . Chronological
(' Alphanumeric
(' Other (specify) I
(' Not Scheduled Retention Period I \,~'~\:)\~
~~\) 'I
(' Permanent
Retention
C Historic
. Scheduled Schedule # I~\j\\ III Schedule I~}~q) .. .... .1
I (~\ Y"\ w k.~ ... ...
Location
Format . Paper (' Audio-visual ('Micrographic C Electronic
Total Quantity ('Cubic Feet: (' Items Amount: I II Type of Items: I
Annual (' Cubic Feet Amount: I I I Items I I
Accumulation
Frequency of Use ('Daily (' Weekly ('Monthly .. Seldom C Never J
Restrictions on Use IN/A
.
Records Are: In Poor r Vital (Essential .Official Copies
r Condition to Operations)
Name of Person Completing Record I ~<\{\\.- \)li'\iL~ .1 Date I "--\- ~., \\ 'I
..,
New York State ArchIVes
JCM (201 1-01-05)
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