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Donation Form

Sindecuse Museum Donation Form
Name

First
Last
Email
Phone

### 		-
### 		-
####
Location
Object(s)
How long have you owned the object?
How did you acquire it?
 Purchase 
 Inheritance 
 Gift 
 Found 
 Other, please specify: 
Who made the object?
When was it made/purchased?
Where was it made/purchased?
Of what materials it is made?
Did you perform any repairs or make any changes to it while it was in your care?
 Yes 
 No 
If yes, please explain:
How was it used?
Who used it?
When was it used?
Where was it used?

From whom did you acquire it?

Name

First
Last
Birthdate
Relationship to user
Relationship to you
Place of Birth
Marriage Date
Spouse
Children
Lived Where
Occupation
Death Date
Were there any previous owners? If so, who? What was their relationship to the most recent owner?
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