Box 184
Records Inventory Data Worksheet
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See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Department IJ\~L,\)\J1\1i:,^
Government Agency IJ()WY\"\)\d\J~.~X\ ;{L
Record Series Title
Date Span
Records Series
Description
(describe content
and characteristics
of records)
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1_2h.~'~~
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'{i\ ~ \ ~ V( ~ S T L..11'N'\\"'~
~ { ~ ~"'" "d--IJ \) ~
.....<_ ,<<_~lt~,<....b:,<, _~1.~\~~tt~_.._.._.__..... <
C Alphabetical
C Numerical
Arrangement . Chronological
C Alphanumeric
-""', Other (specify) I <,..
l,
C Not Scheduled Retention periOd! ~ y ej,j ~
C Permanent
Retention n. _..m'....._...._........~...~. .... ,.. ............M...._....,....__...._.. ......_-....-.
C Historic
. Scheduled Schedule # L~~1b~!1 \ Schedule I ..: I
.n._'_"""_' . ..........._...._........m._.. ...m...m.....
IC.hJy\W (r.i"h \.-. ~
Location
Format . Paper C Audio-visual OMicrographic C Electronic I
Total Quantity ('Cubic Feet: (' Items Amount: I .. : I Type of Items: I
Annual ('Cubic Feet Amount: L < <, ..",..1 \ Items L \
Accumulation .......-.. .. M_..'.....
Frequency of Use (' Daily (' Weekly ('Monthly . Seldom (';Never I
Restrictions on Use \N/A,
Records Are: In Poor 10 Vital (Essential (''official Copies
(' Condition to Operations)
Name of Person Completing Record I \\e.. ~ \V\ L- \),",~L~\ .\ Date I ~ - ll\ "\ d- \
J - -
New York State ArchIves
JCM (2011 01 05)
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