Box 51
Records Inventory Data Worksheet
See instructions in Publication #76, lnvenwry and Planning, before completing this form.
la. GOVERNMENT/AGENCY
--town
2. RECORDS SERIES TITLE
lb. DEPARTMENT/UNIT
~ece(v-er od
c;;; 0 I d.
3. DATE SPKN
c:90(~
(j
4. RECORDS SERlES DESCRIPTION (Describe content and characteristics of records)
cJO {J.
f6~-t MeA ~(jrt~
peLl & 6;( I s ~or-t5
ExvJc D-efosli ~rl-:r
_ 0 f)a;& +00c b: lIs
(2 ..e..,tv{ (l cop ('e/s" ~ r
rnWcP- AD~
)-0 (J
5. ARRANGEMENT
o Alphabetical 0 Numerical
o Other (Specify):
6a. RETENTION
o Not scheduled 0 Permanent
RChronological
o AJphanumeric
o Appraise for historical value
G Vrs
~ ;2019
)l(Scheduled retention:
6b. SCHEDULEAND ITEM NUMBER, OR.R.EASON.FOR.PROPOSEDRETENTION
(f\(j-(
(,[5C1r]A
7. LOCATION
COif Vl wcc,fu
8. FORMAT
Ji't:?aper 0 Audiovisual 0 Micrographic 0 Electronic
g. TOTAL QUANTITY (In cubic feet or number of items),
)lO.cubic feet: (6.J...6' c -f 1- 0 Items:
10. ANNUAL ACCUMULATION (In cubic feet or number of items),
o Cubicfeet: 0 Items: . Ilf?}
11. EREQUENCY OF USE,
o Daily 0 Weekly
12. RESTRICTIONS ON USE
NA
Type of items:
~ever
o Monthly
o Seldom
RECORDS ARE
13. 0 IN POOR CONDmON
14. 0 VITAL (Essential to operations)
15. AOFFlClAL COPIES
16a NAME OF PERSON OMPLETING FORM
16b. DAJE
'&0'(.
~I
-
) CA.xes
GPS2{1212002)
92..7992592-146 COC