Box 12
Records Inventory Data Worksheet
P.rintForm.
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
I Department
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Record Series Title I
Date Span L
Records Series
Description
(describe content
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of records)
c
C
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r
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Permanent
Historic
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IL~?\1:... i Ischedule
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Schedule #
Location
Format r Audio-visual r Micrographic
Total Quantity r Cubic Feet: r Items Amount: I I
Annual r Cubic Feet Amount: I i..
Accumulation
Frequency of Use r Daily r Weekly C:Monthly ('Never
Restrictions on Use IN/A
Records Are: In Poor r Vital (Essential ~cial Copies
r Condition to Operations)
Name of Person Completing Record I bC>f\n6... L<2..D .
New York State Archives
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Date I. ..~ tJ& .6 :lb\
JCM (2011-01-05)
Records Inventory Data Worksheet
P.rintForm j
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
..........
I Government Agency I ro l1)J.j OEW/~ PPiAJ&tR. I I Department If<. ~c.Id-.(/~ nfJI'J
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Description
(describe content
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C Alphabetical
C Numerical
Arrangement C
Chronological
C Alphanumeric
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c
Other
(specify) I
Retention Pec;Od!
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c
Not Scheduled
c
Permanent
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Scheduled
Schedule #
1(.,55I.i2-____i I Schedule
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Location
r Audio-visual rMicrographic r Electronic
Format
Total Quantity
C Cubic Feet:
C Items
Amount: I .
Type of Items; I
Items t
Annual
Accumulation
C Cubic Feet
Amount; I .
Frequency of Use C Daily
r Weekly
(""Monthly
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Restrictions on Use IN/A
Records Are:
In Poor
r Condition
C Vital (Essential
to Operations)
.........
Name of Person Completing Record I bo f'\())- L ~n'ne-rt
New York Srare Archives
. Date I vA iJ
Records Inventory Data Worksheet
'- P.rintForm. J
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
.......... I Government Agency I Tow t0Qt-Wf\PP(J\J0-.&11 Department I R-t=.cRE,& no to
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Date Span L ..dD09t ...
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(describe content
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C Alphabetical
C Numerical
Arrangement ('
Chronological
C Alphanumeric
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c
Other
(specify) I
Retention periodj
C
Not Scheduled
('
Permanent
Retention
C Historic
c
Scheduled
Schedule #
rtfSla.:tJ' _._.../ Schedule
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Location
(' Audio-visual ('Micrographic (' Electronic
Format
Frequency of Use r Daily
('Monthly
Type of Items: I
Items t
Total Quantity
C Cubic Feet:
C Items
Amount: I
Annual
Accumulation
C Cubic Feet
Amount: I
C Weekly
('Never
Restrictions on Use IN/A..
Records Are:
In Poor
(' Condition
r Vital (Essential. /.00 . I C .
, . 00f1 Cia opJes
to Operations) ...
Name of Person Completing Record
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Date I.J\ u
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New York State Archives
C Alphabetical
C. Numerical
Arrangement C Chronological
C Alphanumeric
r- Other (specify) I
("' Not Scheduled Retention periOd/
("' Permanent
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("' Scheduled Schedule # I ,t 5 <-11: ...._ -II Schedule I I
,._..~.--_...-... ----....-.-..-.... --.. ,._.,..~ .-.... .-... ---
Location ICB i4JLU~THm
Format ~per ("' Audio-visual ("'Micrographic C Electronic
Total Quantity ("' Cubic Feet: ("' Items Amount: I ., Type of Items: I I
Annual ("', Cubic Feet Amount: I j j hems I I
Accumulation . ..
Frequency of Use ("'Daily ("' Weekly C,Monthly ("'~om (',Never
Restrictions on Use IN/~m.. I
.'.-.-_.'. m. . . ... ..-....---. ~. .
Records Are: In Poor C Vital {Essential r~cial Copies
("' Condition to Operations)
Name of Person Completing Record l'DOf\f\O.. l~V'Ur+- ,/ Date L.J\ u q :3 .clO II I
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........
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Government Agency I 'fOLl?v'"\. oS . . W
Record Series Title
Date Span
Records Series
Description
(describe content
and characteristics
of records)
New York State Archives
Records Inventory Data Worksheet
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
I Department
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P.rintForm. 1
JCM (2011-01-05)
Records Inventory Data Worksheet
Print'Form .'J
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
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Government Agency I
Record Series Title I. .
Date Span L ,
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r Not Scheduled Retention periOdl
C Permanent t "116
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r Scheduled Schedule # [~.f.?1-~ 1- I Schedule
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Location
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Total Quantity
r Cubic Feet:
r Items
Amount: I
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I.
I
Format
Annual
Accumulation
r Cubic Feet
Amount: I
Frequency of Use r Daily
r Weekly
{:Monthly
r.,Never
Restrictions on Use INIA
Records Are:
In Poor
r Condition
r Vital (Essential
to Operations)
lCial Copies
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Name of Person Completing Record I 'Do () nCL.lQ.:{\()["1-
New York State Archives
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JCM (2011-01-05)
P,ri nt Form j
Records Inventory Data Worksheet
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
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Government Agency ITownoi' .Uh
Record Series Title
Department
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Retention ... .'. ._... _m ._u . .....__,.~ .._...... ._.._u_,_ ..._ .
C Historic
C Scheduled Schedule # 1~I.f3~ltt~1.i II Schedule I .../
.-. .....-.. "....
Location C'" RI\JW~1"t-\
Format ~per r Audio-visual ('Micrographic r Electronic
Total Quantity r. Cubic Feet: r Items Amount: I ., Type of Items: I
Annual r Cubic Feet Amount: I . .......Jlltems t I
Accumulation . ..----.
Frequency of Use CDaily r Weekly ('\Monthly ~Idom r,Never
Restrictions on Use IN/A. I
.'.__. .. .-. .
Records Are: In Poor r Vital (Essential ~fficial Copies
r Condition to Operations)
Name of Person Completing Record IOOfll\Q LQ'O'y\ art- ,/ Date I --At) G-3ao \, I
'-'"
New York State Archives
JCM (2011-01-05)
Records Inventory Data Worksheet
P.rint'Form J
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
"-'
I Government Agency I To wJ,.) Of WfWP, t\XreR.
./1 Department
Record Series Title I .wA\.cRsl.jf1\{)L bTt~ 1 ~..
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Records Series
Description pro~Q...~
(describe content
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1- .-...- -....-. . ... m.... _...._ ..
R.t:.- c..~tjnl 0....)
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C Alphabetical 6i9
(' Numerical
Arrangement C Chronological
C Alphanumeric
C Other (specify) I
(' Not Scheduled Retention periodl
C Permanent ..10.._ \IRS
Retention
C Historic
C Scheduled Schedule # 1,~?E.J~1)D:r__d I/SChedUle I. - ...1
.... .....
Location Ie A Rt\jUJ 1'\11-\ ...
Format ~er r Audio-visual ('Micrographic (' Electronic I
Total Quantity C Cubic Feet: r Items Amount: I . .' I Type of Items: I
Annual C Cubic Feet Amount: I. J 1 Items t. I
Accumulation . .......
Frequency of Use ('Daily (' Weekly nMonthly ~dom II n Never
Restrictions on Use IN/A.
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Records Are: In Poor r Vital (Essential ~cial Copies
r Condition to Operations)
Name of Person Completing Record "DO\f)f)Q. LQ..{'\~\- ',/Date I -->\0(\. .3 ;;to t I I
New York State Archives
JCM (2011-01-05)
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