Box 45Records Inventory Data Worksheet
See Instructions in Publication t76, "Inventory and Planning", before Completing Form
Print Form
I Government Agency ~ I Department
_ _ O w 11_ c}~__ ~,)
Record Series Title
__ .
Date Span
_.__ ~O.6_~ _~ __ ~ ~__
Records Series ~ ~' ~~ ~ ~ r ~~ ~~ . 1 / ~ L1 ~/~
Description "r (~' ~ v ,/ J P C
(describe content ~Q~ / .... ~~ / `~
and characteristics v
of records}
(' Alphabetical
{" Numerical
Arrangement ~~~ Chronological
Retention
Location
Format
~' Alphanumeric
~ mss'
(' Other I (speciry)
~": Not Scheduled
Retention Period
Permanent Q r ~~~~~"~"~
Historic
~'` Scheduled SchedueE
{Paper ~" Audio-visual
Total Quantity ~"'` Cubic Feet: ~" Items
Annual
Schedule
rnv ~
~'.Micrographic (' Electronic
Amount: Type of Items:
Accumulation ~ Cubic Feet Amount: ~ Items
- _. __
Frequency of Use {`' Daily !" V~Jeekly ('.:Monthly ~ Seldom ('.Never
Restrictions on Use ~N/A
Records Are: In Poor Vital (Essential
Condition ~ to Operations} (' Official Copies
Name of Person Completing Record (--'
Date
New York State Archives
J M (2011-O1-OS)