Box 186
Records Inventory Data Worksheet
1.,print'Form
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See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Government Agency I }C)W Y'" lJ\\J .c..--..
Department I I\~Gtl\)f\t1:\J\ .
Record Series Title
Date Span
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Records Series
Description
(describe content
and characteristics
or records)
C Alphabetical
C Numerical
Arrangement . Chronological
C Alphanumeric
C Other (specify) I
......._.-.
C Not Scheduled Retention periodj \0
I'tW ~
C Permanent
Retention ._.....__.~...._....._._.__~............._....M...m...u_. .... m.._ .n. ...__..____..
C Historic
. Scheduled Schedule # IJ.\~_\~~..~.L: II Schedule I ....I
-........ ...d.__ ....".-......
IC~l'0W~\h ~- -
Location
m. ......,
Format .. Paper (' Audio-visual CMicrographic C Electronic I
Total Quantity CCubic Feet: (' Items Amount: I ....1 Type or Items: I
Annual ('Cubic Feet Amount: I.... ... .........J jltems L. \
Accumulation ..-._.-........ ~_..--........
Frequency of Use ('Daily (' Weekly ('Monthly . Seldom ilONever -I
Restrictions on Use IN/A
. .
Records Are: In Poor <0 Vital (Essential .,Official Copies
(' Condition to Operations)
Name or Person Com pleting Record I \\t. ~ \V\ L- D "''\.)LLJ .~ I Date I ~ - l~ "\ci- I
J - -
New York State Archives
JCM (2011 01 05)
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