Box 05
Records Inventory Data Worksheet
~~'
\~I'~ I "i]
}'v;:' ".~gi;).P,r,ir:rtEO/Tll>'4
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
~
GovernmentAgency IJh. .f\o:f...wo---..
Record Series Title R ts;,~\ PJ~ .
Date Span 1.._. ..a.QQ5 =- ~OjQ
(' I Department
Ig.~c.8-_~BJ}.c A). _,,
Records Series
Description
-, R \ PS I P L A'l G- R OU'iY 0 I ,A'n-\Lt: \) C. P ~ 06- fZ.f\. IfY\'\
(describe content
and characteristics
of records)
......
C Alphabetical
r Numerical a\t
Arrangement V Chronological
&
C Alphanumeric
C Other (specify) I
. ..-
r Not Scheduled Retention periOdl
C Permanent ~ 1- "IRS
Retention ...... --.----- . ... .-. -. . -"~ _.- .-............-- . - --,-._-..----....',.._..-
C Historic
C Scheduled Schedule # It}! i ~~_~ J.__.. j II Schedule I II
- _..._ .".__"____"'_'''_ _.___u. _._..__
Location ICf\Rk)UJ&Jl.t . :
Format ~per r Audio-visual eMicrographic C. Electronic
Total Quantity C Cubic Feet: C Items Amount: I Type of Items: I
----. .-,-.
Annual CCubic Feet Amount: I J Items I
Accumulation - I ...-.,'----. ...--- ..-- --~ .......~..'.~.... .-... _.---.. ------.
Frequency of Use CDaily r Weekly ("Monthly r Seldom ONever I
Restrictions on Use tN/A. I
._n..__' ,._.__u_ . .~. .., _.______..__u_.. . ... -- --.'" .... ...... .--~-....~- .. ..-- ... ._._---~...
Records Are: In Poor r Vital (Essential cfb>fficial Copies
C Condition to Operations)
Name of Person Completing Record I ~O(\ (\G.-. Ls 'OY'\,<T~- .1 Date I .,.ttUcY. L.ac:)\) I
..-....
......
New York Srare Archives
JCM (2011-01-05)