Box 198Records Inventory Data Worksheet
See Instructions in Publication r76, "Inventory and Planning", before Completing Form
Pilnt FOi ~T'r
Government Agency - _ ~ ~ ~ ~ Department l i ~ (eC.~ 0U
Record Series Title ! \ ~' '~, a ~,
Date Span
_ +3... _. _ _. VY~~._ 1 __. ~?.\. _._....... __ __..._._ ___
_ '\ ` ~ ~._. _~~.
Records Series
i ~ ~~ -~ i ` ~ ~ C
~~~'~~~ ~ ~ ~, tS ~~~' ~ 1
on
Descript
ribe c
ntent
(d ~ `~V~`~ 1 ~
esc
o
and characteristics
of records)
('; Alphabetical
(^. Numerical
Arrang°ril2nt I;;~ Chronological
~"; Alphanumeric
~', Other I (speciry)
~: Not Sche duled
Retention Period ~ \ ~ h ~
~
Permane
~:
nt
l
__._.
___-_- -._..
_
Retention
(' Historic
Scheduled Schedule ~ ~'1 ~ Schedule ~ ~~ ~!
Location
Format I~ Paper (':Audio-visual ~"-PJlicrographic I t. Electronic
Total Quantity I~ Cubic Feet: (" Items I Amount: ~ Type of Items:
Annual I~..CubicFeet Amount: Items
l Accumulation --- -- --
Frequency of User' Daily I (`' V`Jeekfy I ~ ,:Monthly ~ Seldom I ~" Never
Restrictions on Use N/A
~., In Poor I ~., Vital (Essential ..Official Copies
Records Are: Condition to Operations)
Name of Person Completing Record ~~~ ~~~` 1~ wyZl~~ I Date ~~,, ~ ~~ ~~
New York State Archives JCM (Z01 1-05)
~~X ~~ ~~