Box 39Records Inventory Data Worksheet Pant Form
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
_ ~ Department -~Q, (~ Se. C.~~ ~
Government Agency - t f ~ ~~~~~'
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Record Series Title _
Date Span ~_ t ~ lP I ~~ I 1 ~ l I'~ A- /~s ~~ LR- ~ n ~~
Records Series
Description
(describe content
and characteristics
of records)
(~ 3 p 1 O I~ I~- ,U S ~-C7' t 0 ul~
a~ S~~ r ~ IS
~ Alphabetical
erica) •~
{~ Num ~~
ti
•,
arrangement (' Chronological
~, Alphanumeric
(^: Other (specify)
~ Not Scheduled i1 _„ ~~ ~~
Retention Period ~ ~'` s tJ-~~
Permanent / v -- ~_
Retention
~~ Historic
Schedule __._..
Scheduled Schedule # ~~
Location
Format r~ Paper (" Audio-visual ~"-Micrographic (' Electronic
Items Amount: ~-~ TYPe of Items:
Total Quantity (Cubic Feet: ~
Annual ~ Cubic Feet Amount: ~_ ~ Items
Accumulation
Week) {"..,Monthly {" Seldom ('.Never
Frequency of Use ~" Dai-y C` y
Restrictions on Use N/A
In Poor ~,., Vital (Essential ~ Official Copies
Records Are: ~ Condition to Operations)
Name of Person Completing Record
New York State Archives
~^~ ~ ~~~ ~ Date ~l ~ ' ~)
JCM (2011-01-05