Box 30Records Inventory Data Worksheet
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Print Form
Government Agency .Q~,n ~ U 1 -
_ U Department r--~~'i~- l ~-P~aS
~
RecordSeriesTitle ~'S --~-Q~~S-'~CY(O~ ~VU~-Nd4[.S
Date Span ~ ~ j ~ ~ ~ - ~'3p/ p~
Records Series ~~
~ ~ 5 ~~ ~ ~S ~-C T f ~N ~d t L.le ~ ~ C~
Description
(describe content I ~~ 1 b ~ ~ ~ ` 3~ ~ ~
and characteristics
of records)
v i
~`' Alphabetical
~/,~' //
(~i Numerical " ~
-%'~
Arrangement (', Chronological
~"' Alphanumeric
(' Other (specify)
(` Not Scheduled
Retention Period ' n~~ ~ e~ ~ 6 ~ ~
i^ Permanent ~.Y ~.J
Retention --
(" Historic
~ Scheduled Schedule# ~ ~s~ Schedule ~-
Location
Format t~lPaper (" Audio-visual (".;Micrographic {" Electronic
..
Total Quantity ~ Cubic Feet: ("' Items Amount: i J r Type of Items: ~~
Annual "-'
Accumulation ~' Cubic Feet Amount: ~- Items
Frequency of Use ~' Daily ~` Weekly ("'..Monthly (' Seldom ('.Never
Restrictions on Use N/A
In Poor Vital (Essential
Records Are: ~"" {' ('-official Copies
Condition to Operations)
Name of Person Completing Record ~~~ ~ ~ ~ ~ Date
New York State Archives
~(~li~
JCM (2011-01-OS)