Box 15
Records Inventory Data Worksheet
I cp.rirTrForrn: .
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
GovernmentAgency IrOW_.A2._D_E _W/J_f!PIA)(}(giIIDepartment
Record Series Title L __
L_d d_
'.dAcCfl.tfVD()lL.
~
Date Span
A..Jt.id,).-5 f?LlPf:R- CLi I?I2L).}{i-~- -.--. ---- .
I
.19.1fQ:i-.~j9jQ-~~-- --- -----.. --------- -----.-- ----------.-- ..---..------- ----------.- ------ ------
Records Series
Description
r 012. 'H t 5 TlJ/2.1 C/o} L
QCLO~D.s
(describe content
and characteristics
of records)
.___ _._.._......._..._._.. - _.~ ...___. ,,'__'~>' _~___..~...__.. ." ____.__.~ _n__
~
C Alphabetical
C Numerical
Arrangement C Chronological
C Alphanumeric
C Other (specify) I
-. .. '_-0 " ~.-
e- Not Scheduled Retention periOdl
C Permanent f4_R._1!! ~ /lJ~[l!_L
Retention .--~ --.."---- .. ..-....-.---..
C Historic
C Scheduled Schedule # 13_6D-----.11 Schedule '----- --------- ---JI
Location I C_~.fYJ.lA)~ill-..
Format I~per C Audio-visual CMicrographic C Electronic
Total Quantity ("'-Cubic Feet: C Items Amount: I dilType of Items: I J
..-'" 0"- .- .---" _. .u._._._.... _.. ...-..
Annual C Cubic Feet Amount: I JI ~ nems I I
Accumulation .--.- . .~.., -..---.. ~._._.._.n._'.'_ ... ._--.-_.-.... ._._-._---,_.~ .. _..-. .--.....-....---.- -. ---. .-
Frequency of Use CDaily r Weekly (\Monthly ~om C Never
Ii II
Restrictions on Use IN/A_ . __ ..__ d_H_ ....1
. .------- ... ..-'.".- .--..--..,..--,- ...._. . --.-..-.....-. --.- -.- ..-.-- ... .- ..._.,_..~.._--_.__._---"'.----_._-,... ...- --- ---.-..._----- ..
Records Are: In Poor r Vital (Essential -L.,c,
r Condition to Operations) ~_ ,umcla oples
Name of Person Completing Record I Jx>l1.rtL _Unhuct. J Date I _A_Uc;.-<.jHcJ._Q j] H
-- --
'-J.
New York State ArchIVes
JCM (2011-01-05)
'-"
Records Inventory Data Worksheet
~rint;Form~: i j
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
~
Government Agency I TO l-t?A2 . . OF W/JPJ}}AJ{keR. . Department L BEC.REiJ.710tJ .
__.____.m~_..._
Record Series TItle I ...miO/!$
.. .-....-.--- -.'. ." _..._._~--_...... .-_.._-.--","" __ _n' _.____._ .....-.._.--. .--" --.',-------. -"'. ... - .._..._,.-.~.".,- -'- --_. -_.- ,~_.- - ,-.-._. '..
Date Span L. .....L91Q~...:: ~Q()S
.......-...---.- ._._____m.. .-.--.- - .m........__...._'. ...._..__.__...._.u__~ ..._._- --- -. .'-.. .----. _._- -. -_...~. . .. ..... ,-,-~-,-,--,,---,"_.' "-' ..
Records Series +I/5TD4 I CIVL V.l~ L ut / s I(]-).)/ FJ C IUAJGc.
Description F {) /:J. T7-16 T!) W;U . rn tv Pf> I S(!j.-/ fY} /i> 71 C~
(describe content A () 15/AJ So A.J LIV;t)t mfJiCT-d, CID5 fU::- k)/)Jt) .
and characteristics :5C'l-/ LfVTl-I/VU S 1 CH(:jL~tfJ l30rvT pJVmP, tYJOAJ/pol20r
of records)
&..1 AR.. '-FIVe
.. "" n. _. .__ ._._~... __ __, --.-._~--.- ..-.---.- . .. .... - - ...- . .._.___n_.__._ . 'u' -...- .__,_ ___ BU
c
Alphabetical
c
Numerical
Arrangement C
Chronological
Alphanumeric
c
c
Other
(specify) I
Reten_ periodl
P tf< '!J. ~~~A1T.. 'uH.
~
c
Not Scheduled
c
Permanent
Retention
C Historic
c
Scheduled
Schedule #
Idt~~_~,~ ;I u_,....111 Schedule
I ... _._. .. .H.n..:!
Location
ICft~~uJ~.n1,
('~per r Audio-visual ('Micrographic C Electronic
Format
Total Quantity
C Cubic Feet:
C Items
Amount: I
Type of Items:
I
I.. _. ..
Frequency of Use r Daily
C Weekly
(':Monthly
_'H . .... ... j Items
~Idom
o Never
Annual
Accumulation
CCubiC Feet
Amount: /.
Restrictions on Use IN/.A.
Records Are:
In Poor
r Condition
C Vital (Essential II_~ . I C .
to Operations) C"'uI/ICla oples
~ Name of Person Completing Record I ADO()nG. ..LE nh4/'t
New York State Archives
. ... ',IDate J .AU6-3~<?t I..
.,
JCM (2011-01-05)