Box 45
13o'C l( r
Records Inventory Data W orlc.sheet
See instructions in Publication #76, lnvenwry and Planning, before completing [hIS form.
la. GOVERNMENT/AGENCY
--r Own oJ W
2. RECORDS SERIES TITI...E
lb. DEPARTMENTIUNIT
3, DATESPKN
~ d-X
-z.,.--
4. RECORDS SERIES DESCRIPTION
'J-011jl )-
~&
eu
~-~
5. ARRANGEMENT
o AJphabedcal 0 Numerical
o Other (Specify):
6a. RETENTION
o NO[ scheduled 0 Permanent
~)eduled retendan:
~nOIOgiCal
o Alphanumeric
o Appraise for historical value
6b. SCHEDUlEAND ITEM NUMBER, OR.REl\.SON.FORP.RDPOSED.RETENTION
7. LOCATION
8. FO~T
Q'Paper 0 Audiovisual 0 Micrographic
9. TOTAL QUANTITY (In cubic feet arnumber of items),
~biC feet: 0 Items:
ic feet or number of items),
o Electronic
\J\f1
o Cubic feet:
o Items:
11. .F.REQUENCY OF USE,
o Daily 0 Weekly
12. RESTRICTIONS ON USE
o Monthly
o Seldom
RECORDSARE
13. 0 IN POOR CONDmON
14, 0 'jRAL (Essential to operations)
15. ~OFFICIAL COPIES
16a. NAME OF PERSO MPLETING FORM
New York State /lrchives
~
\. c:: 5 q6 "J
ce\ vef of ---ra..
A-
~~
~ \.LD
lo~
C :;lOll
C ~C15 -~ Dr
Type of items:
~er
16b. DATE
GRS-2{1212002)
92-7992592-146 CDe