Box 44Records Inventory Data Worksheet PrintForn,
See Instructions in Publication ;`76, "Inventory and Planning", before Completing Form
Government Agency ~ +r~i~~ ~_l n r Department ~~~ ` ~~
Record Series Title 1
Date Span ~J~
~__.__ _.I~~~/_~_~__. __ .__....
Records Series
DescnpUon
(describe content
and characteristics
o` records) + ~ ~ (L ~ ~~~ ~~
1~ ~
~ ~ ~ ~ ~ ' ~ `'
rR Alphabetical
Numerical d~
Arrangement {" Chronological
;'" Alphanumeric
(' Other (speciy)
Not Scheduled
Re.ention
~". Permanent Retention Period
~ ~O 1
`~
__ .
_ ._ _ __.
_ .. _..__
__. ___
~
Historic
~ Scheduled Schedu(e~
- -- _Z __ ___ Schedule
l _ _ ___
Location ~ ~ J~
Format i~ Paper ~' Audio-visual (':Micrographic ~" Electronic
Total Quantity
Annual
Accumulation ~` Cubic Feet:
r'' Cubic Feet ^ Items Amount: ~
_...
Amount: ~- Type of Items:
Items ~
Frequency of Use (" Daily ~VJeekly i Monthly (' Seldom I (':Never
Restrictions on Use I I~iJA
IRecord5 Are: ~-. In Poor
Condition Vital (Essential
~ to Operations) {~Of IClal Copies
I
Name of Person Completing Record ~ ~ C..O ,. ` ~
• W Date I
_~~~~ ~urx~rare~;rcnwes ~ ~ JCM(2011-O1-OS)