Donation Form

Name of Person or Organization making this donation or loan

.____________________________________________________________.DATE._____________

We are honored you have chosen to make a gift or loan to our organization. To give proper display and recognition could you assist us in documenting the history of this item.

Is this a gift, or is it a loan to our organization. GIFT._____ LOAN._____

If this is a loan, please indicate who you authorize to retrieve the item in the future.

.___________________________________________________________.

Stipulations:_______________________________________________________________.

Other than yourself, who else owned this item in the past? (Other family members etc)

._______________________________________________________________________________

Describe the item(s) and indicate from what era or year it came from

._______________________________________________________________________________

Any other additional information or background and history of this item(s). The more information you can provide, the better we can give proper recognition and feature such item(s) to those who visit our museum.

._______________________________________________________________________________

Name (Please Print).____________________________ Signature ._________________________

Accepting on behalf of the Chaffee Historical Society.____________________________________

Item ID#.________________________.