Box 183
Records Inventory Data Worksheet
I,' ~'PJinff~rm<~:.l
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
(describe content
and characteristics
of records)
Department .. tf\d~L\)Yf\\i:\l\
Government Agency I ]'C)\J0Y\ ~ 'd
Record Series Title
Date Span
Records Series
Description
::s \l \~ \ b \)< <. { v" ~ ( &..\\ ~ ~
,'t ~r?s~ '
C Alphabetical
C Numerical
Arrangement . Chronological
C Alphanumeric
C Other (specify) I
. ...
C Not Scheduled Retention per;Odl_ ~ 't~\ ~
C Permanent S S
Retention ... -._......."....~.-.. ..,....n'_..._ ................._.....__..._.._..__h..... ........--.
C Historic
C Scheduled Schedule # 1...._\:\)~:L51d__ -\11 Schedule L d: I
...... .... .-'"
IG~J'0W ~lh I-... .......
Location
Format .. Paper C Audio-visual CMicrographic C Electronic
Total Quantity C Cubic Feet: (' Items Amount: I .. .\ Type of Items: I \
Annual C Cubic Feet Amount: I d \ I Items I \
Accumulation
Frequency of Use rDaily r Weekly CMonthly . Seldom (',Never
Restrictions on Use IN/A
Records Are: In Poor . Vital (Essential (',Official Copies
r Condition to Operations)
Name or Person Completing Record I \\t- ~ \V\ '- D"'~L(J .\ Date I ~-t1'Yd- I
0 J
N~w York State Archives
JCM (2011-01-05)
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