Box 180
Records Inventory Data Worksheet
I" ,'.' printForm. ::;1
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Government Agency I ~~W(\... ..~.~......~..~OD\1\ lid'(.. Department I \\.~ \)\) 'f\. }\Y) lr-....... .
......
Record Series Title \;~e~'\):t~3:\~~~~\J..~.
...-.--....,.._........_.....-.. .. ...................---....--.......... .. .......
Date Span I..~\.:)~J.......
.........---.. ........_....h.................. .....-...-........... ..___._.m.............._.... ..._.._._.......
\ , S,,{{.\~
Records Series \VY\t
Description
(describe content ~t \ ~
and characteristics
of records)
................
('
Alphabetical
c
Numerical
Arrangement ..
Chronological
Alphanumeric
c
('
c
Permanent
(specify) I . ...
Retention perlOdl
~ 'i~"1~
Other
c
Not Scheduled
Retention
C Historic
. Scheduled
Schedule #
It5-2':\'.\1_ ........!II Schedule
"-
I.. .
I
Location
I( ~!Y\ ~",\b.
Annual
Accumulation
('Cubic Feet
C Audio-visual OMicrographic (' Electronic
C Items Amount: I . .... ... ...IType of Items: I \
Amount: t I I Items t \
... ..
C Weekly OMonthly . Seldom (',Never I
Format
. Paper
Total Quantity
('Cubic Feet:
Frequency of Use C Daily
Restrictions on Use IN/A...
Records Are:
In Poor
C Condition
_ Vital (Essential r-.Offi' Ie'
tW 0 t' ) \' ICla oples
to pera Ions
Name of Person Completing Record I ~N.A. ~..... ~ ..:1'
,,'
',I Date I ~-, '\' \1- '!
JCM (2011-01-05)
New York State ArchIves
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