Temporary Custody Receipt

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This form is used by the Laurel Historical Society to establish temporary physical custody of items before the decision is made to formally accession the items into our permanent collection. This form may be completed online but arrangement to drop off the items at the Laurel Museum must also be made.

Please print a copy of this form and bring it with your items for drop off.

Please direct any questions to info@laurelhistoricalsociety.org

This is to acknowledge receipt of the items listed below by the Laurel Historical Society & Museum from:

Today's Date
*

YYYY

Name *

Address *

Phone Number *

Email address *

The items listed below are left in the custody of the Laurel Historical Society to be considered as: *

An unconditional donation. The Museum reserves the right to keep, lend, or otherwise dispose of the donated material.The LHS may use the material on our website, for social media or other postings, in promotional materials or in future exhibits or outreach activities.

For identification. Does not constitute an authentication; will not include appraisals. Museum reserves the right to photograph.

Exhibit loan.

Other:

Disposition if not accepted for accession: *

Source will pick up

Please dispose of or destroy

May be sold or used to benefit the Laurel Museum

Items and descriptions *

Please fill in a brief description of each item, to include dates and materials, if known. Include any relevant history or provenance.

Received from: *

Your full name typed below will serve as an authorized signature on this form.

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