Box 179
Records Inventory Data Worksheet
..... :Pr,infForrri'il
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Government Agency I."\.~ \,JoJ'f'\.\)-\~b .... AY\ . fe. Department t .f\~"-tl\.i),\\\Y\
Record Series Title~h.1"-\:\'f\ (,~~~~"'i\),~;'\-\~f.\),.. ....... .,__
I_~~~~.
Date Span
Records Series
Description
(describe content
and characteristics
of records)
Arrangement .
Retention
Location
Format
Total Quantity
Annual
Accumulation
\)\)(. \" \Jvt ,r~~ ~~\)'\
~'^\~( X'-l,^,~ ~~!~~~ ~~~~
\)k",,\l S1~-\ '('C\';~~ ~,,~\
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~t,l;~"l'\lA \~ ~~ ~V'6 ~,~ ~
CJL\-. ~~v ~ \. W j-{t' D-<~C>':l~h
c
Alphabetical
c
Numerical
Chronological
c
c
c
Alphanumeric
Other
(specify) I . ...
Retention periOdj
\, ~'"t 1...1 ~
Not Scheduled
c
Permanent
C Historic
. Scheduled Schedule #
I CCt-1'0~~\b ...
J~X~\i]m'_', II Schedule
j
L
. Paper
C Audio-visual CMicrographic C Electronic I
('-Cubic Feet:
C Items
Amount: I
. . ... ]\Type of Items: I
H.'I \ Items L
I
CCubic Feet
Amount: I
Frequency of Use r Daily
C Weekly
('Monthly
. Seldom
II C,Never
Restrictions on Use IN/A.
Records Are:
In Poor
r Condition
. Vital (Essential r-.Off" I C '
O t' ) ~, ICla oples
to pera Ions
New York State Archives
Name of Person Completing Record I -\~I LA~
...... '1\
"
IJV'MIlj
\
I Date I ~ - \ \ ~ \ ~ I
JCM (2011-01-05)
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