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Box 187
Records Inventory Data Worksheet
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Government Agency 1.1\;)Wy\...1~\.
Department 1.f\c.,G\)\Jf\1i\l\ .
Record Series Title
Date Span
Records Series
Description
(describe content
and characteristics
of records)
Arrangement .
Retention
Location
Format
Total Quantity
Annual
Accumulation
('
Alphabetical
c
Numerical
Chronological
c
c
Alphanumeric
Other
(specify) I
Retention periOd!
~ Y~~l~
c
Not Scheduled
c
Permanent
C Historic
. Scheduled Schedule #
IC_~1'0W '^-lh .-p-
rm~~_I~;)_~l_m_: II Schedule
.... -
o Paper
C Audio-visual CMicrographic (' Electronic
('CubiC Feet:
(' Items
Amount: I
. .:1 Type of Items:
. . .J \ Items
I
L.
C Cubic Feet
Amount: I.....
Frequency of Use (' Daily
(' Weekly
CMonthly
. Seldom
Restrictions on Use IN/A..
Records Are:
In Poor
(' Condition
IA Vital (Essential r.Off'r' Ie'
.. 0 t' ) \' kla oples
to pera Ions
Name of Person Completing Record I \\e.. fA \V\ /.- D "'-'.l -.u.., \
New York State Archives J
ONever
1_.'Pri~!'F~rm :~l
pmp: \
-\
\ Date I ~ - l ~ .. r&.-I
JCM (2011-01-05)
~\)~ \~'1
