Box 196Records Inventory Data Worksheet ~ `; rriritForm'
See Instructions in Publication t76, "Inventory and Planning", before Completing Form
Government Agency ~ ~~~ ~~ ~ ~ 1. Department ~-
Record Series Title /~ \ r_
Date Span
0_~i~o c t _ l.~ ~.~ ~ ~ O . .
_ _Z _ ~.1 ~.....
Records Series
Description
(describe content
and characteristics
of records} ~ v~~5 b ~ (~ ~`', ~ V
~ 1J
~~ S ~ W >'~
~ ~ ~ >J ~')
~~~ 4 ~,
~'.: Alphabetical
{'`: Numerical
Arrangement ~ Chronological
~' Alphanumeric
Other (specify)
~'"` Not Scheduled
R
i
P
i
d
Retentinn
{': Permanent etent
on
er
o ~ ~ -~A~
---_ _ _ _.~-__ ____ _....._ _._ _ _ _ __
Historic
~ ~5 Scheduled Schedule ;r
~...._.
__. .-
Schedule ~ ~}
Location
Format I >~ Paper ~ (' Audio-visual ~"-Micrographic f" Electronic
Total Quantity I ~ Cubic Feet: ("' Items Amount: ~ ' Type of Items:
-_
Annual
~ Accumulation
~ Cubic Feet
Amount:
Items
Frequency of Use ~' Daily ;'>rJeekly ;.:Monthly Seldom {"`.:Never
Restrictions on Use N/A
Records Are: ~.-. In Poor
Condition ~, Vital (Essential
to Operations) ..Official Copies
Name of Person Completing Record ~.! I~ wU Z~~ I Date I `~_ _`~_ 1~
New York State Archives If n (2011-01-05)
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