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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?
 
Additonal comments
 
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