Temporary Custody Receipt Form - Monroe County History Center printable pdf download

Temporary Custody Receipt Form - Monroe County History Center

Accession No:__________________

Temporary Custody Receipt Form

Date________________

Name:___________________________________________________________

Address:_____________________________________________________________

____________________________________________________________________

Phone #: _________________________

E-mail address:__________________________________________________

1. I initial that I give the Monroe County History Center (MCHC) the right to take

temporary custody of my possessions listed below for consideration. ___

2. Please initial if this is:

___An unconditional donation. The museum reserves the right to keep, lend, or otherwise

dispose of the donated material once it is accepted (see reverse page for details). Please

leave this section blank if it is not an unconditional donation.

3. Disposition if not accepted for MCHC collections. Please initial one option:

___Donor will pick up

___Materials may be sold to benefit MCHC

through annual sale or auction

4. Initial how you would like to be acknowledged in the credit line for your donation:

___Anonymous

___ Donor’s name:

___In memorial of:___________________

Number of objects you wish to donate:______________________

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Temporary Custody Receipt Form - Monroe County History Center