Box 40Records Inventory Data Worksheet Print Form
See Instructions in Publication #76, "Inventory and Planning", Before Completing Form
Government Agency ~~ ~ Department ~--~~ I,' ~ ~~C.v ~'
Record Series Title -
Date Span '-'~' I __" ~~ ~~ .,_~ _ ~_~~~5 -~UV~~.~_
Records Series
Description
(describe content
and characteristics
of records)
a~j~b `~~I ~a"J31'Ib
-~A,uS A-E'7~~n~ ~'cur'n~(S
Alphabetical
~
~ Numerical ~~
Arrangement ,~" Chronological
("` Alphanumeric
(~ Other (specify)
(" Not Scheduled J l/~~ C ~~ ~ c~ 7
Retention Period (Q r J i
~
~^ Permanent ~
Retention
{`~ Historic
Scheduled Schedule # ~~s'i" Schedule ~-~
~ __
Location ~~
Format ~ Paper (`Audio-visual (^ Micrographic {'. Electronic
i
Total Quantity ~ Cubic Feet: (' Items Amount: ~ ~ . Type of Items: ~
Annual ~ Cubic Feet Amount: ~- Items
Accumulation
Frequency of Use ~" Daily (` Weekly (".:Monthly (' Seldom ('.Never
Restrictions on Us e N/A
ReCOrds Are: In Poor
'~ Condition Vital (Essential ~-...Official Copies
~ to Operations)
Name of Person Completing Record ,e ,`-~ Q,. , ~'~~ ~ Date
New York State Archives j
~~
JCM (2011-01-05)