Box 181
Records Inventory Data Worksheet
,..... .PrinrF6rn1: J
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Government Agency t J ()\)\))"\ .1J -\. ...\.)btp\'f.\lt\~ Lm . Department 11\(..(., \)\)f\ti-\f\h ...
Record Series Title ...bh~\l\Y.\b I O~"rl'.."J:Y.\.-\L.J-1A~Y\ .
Date Span . m?h~~m
Records Series ~\J~ '\ ~ ~'" \( S\J-\~,,~~ th~ 'K 'R-t(.'J ~~~\
Description D~~-\\ ~\\~') ~I:l~~ C ~ k')" ~N~~ ii n~\"I~\:) ~t\J\
(describe content ~h~ \f~~ ~<!::, ~\~\ ~()" lJl' C~\\d(f~\ ~\J-\)\
and characteristics
of records) tf\~, 1. 'Y\ 'tlft\ 1'1'l'\'t"'\ S1~,,^,,,~~ ~\)~
C Alphabetical
C Numerical
Arrangement . Chronological
C Alphanumeric
C Other (specify) I ."
C Not Scheduled Retention periOd\
C Permanent
Retention .....................-.... ..... .........-...... ..... ...... .~_... -,..d'" ................
C Historic
C' Scheduled Schedule # l~\~k~t !llsChedUle 1m ... :1
I Chjy\ W ~\:.'h -
Location
.........-.
Format . Paper (' Audio-visual o Micrographic C Electronic I
Total Quantity CCubic Feet: (' Items Amount: L .m l Type of Items: I
Annual ("'Cubic Feet Amount: I mllltems 1m \
Accumulation .-.....
Frequency of Use ('Daily CWeekly CMonthly . Seldom II C Never
Restrictions on Use IN/A I
Records Are: In Poor <I Vital (Essential ('.Official Copies
r Condition to Operations)
Name of Person Completing Record I \\e.. (,.. \ V\ h D ~"'L(.j :\ Date I ~-l~ 'Jd-. I
New York State ArchIves
JCM (2011-01-05)
~~ \~\