Box 182
Records Inventory Data Worksheet
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See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Records Series
Description
. fm
Department t1\,"L\)\Jf\1i-\'\
Government Agency 11C>W)'"\mt;:)'\m:\..)'"
Record Series Title
Date Span
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(describe content
and characteristics
of records)
C Alphabetical
C Numerical
Arrangement . Chronological
C Alphanumeric
C Other (specify) I
C Not Scheduled Retention per;Od!
C Permanent S S '\ -e... ~1 ~
Retention .. .............- ..................._h................. .....-. .......H.H.H...........
C Historic
. Scheduled Schedule # Imm1~ \l'iiTI illsChedule I m\ I
,. ...... ...........-......
IChjY\W~th,j ....
Location
Format . Paper C Audio-visual ('Micrographic C Electronic I
Total Quantity ('Cubic Feet: C Items Amount: I .: I Type of Items: I
.n.
Annual CCubic Feet Amount: I ... .'llltems I.. I
Accumulation
Frequency of Use rDaily r Weekly ('Monthly . Seldom C Never I
Restrictions on Use IN/~...
Records Are: In Poor . Vital (Essential ('Official Copies
r Condition to Operations)
Name of Person Completing Record I \\e.. (,.,.''1\ I.- D~"LL.j :\ Date I ~- l~ "Yd--. I
J - -
New York State ArchIVes
JCM (2011 01 05)
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