Box 197Records Inventory Data Worksheet
See Instructions in Publication t76, "inventory and Planning", before Completing Form
Print Form
Government A enc _ , !
__. De artment -}
'f~ ..Yi ~ ..
Record Series Title
Date Span ~_V`~e ~ ~ .._~~`~.__.. ~ _ ._ . _V~. .~'J~ ...l~_...~~ _I~ -_ ..
Records Series
Description ~ ~ { ~ \\
V~t~Z'r~~5 ~ ~ ~,t~
r
~~W ~
(describe content ~ ~~,,~~ v`_~
e ~UU l ~
and characteristics
of records)
;~; Alphabetical
~': Numerical
Arrangement ,~ Chronological
C`:
i ,;:
Retention
Alphanumeric
Other I (specify)
Not Scheduled
Retention
Permanent
\I~.~1 S
I~' Historic
~`: Scheduled Schedule ~ ~1 ~ Schedule ~~ ~) i
Location
Format ~j Paper I{'Audio-visual ~'':P~licrographic ('.Electronic
Total Quantity I (": Cubic Feet: {"' Items Amount: ~ 'Type of Items:
Annual
Accumulation I ~' Cubic Feet Amount: Items
____ _ _. _ ... _ __..... ; 1 ...._ _ _ .. _.. _ .
Frequency of Use ~' Daily ~`` UJeekly i :Df~onthly ~ Seldom (`.:Never
Restrictions on Use N/A
In Poor Vital (Essential
Records Are: ~" ~"` ~ Official Copies
Condition to Operations)
Na~ me of Person Completing Record +~ t ~ ~~-Z~-~ I Date ( ~~~ '~~~ l~
New York State Archives ~ J` JC~~O~ 01-05)
~lC, I i