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MUSEUM ARTiFACT INTAKE FORM
FOR USE BY MUSEUM STAFF ONLY
Artifact Name
*
Catalog Item Number
Intake Date (If Known)
Month
Month
Day
Year
Is this a new item intake or is it an existing item within our museum system?
*
New Item
Existing
Is this item part of a set or a single piece or is it a part of a special exhibition?
*
Is this item:
*
On Loan
Donated to Us Permanently
If on loan, when is this item scheduled to be returned?
Item Owner/Donor Name
Item Owner/Donor Name Email
Item Owner/Donor Name Phone
Item Owner/Donor Address
General Description of Item
*
Condition of Item
*
History Associated With This Item
*
Website Link to Additional Information
Website Link to Additional Information
Is this item from Bedford County?
*
Yes
No
Photo(s) of Item
*
Upload File
Certificates of Authenticity/Supporting Documentation
Upload File
Display Options
*
Permanent Display
Rotating Display
Limited Time Display
Who authorized the intake of this item?
Signature of Owner/Donator
Sign in the box or use the keyboard to type.
Signature field is empty.
Clear
Signature of Person Receiving Item Intake
*
Sign in the box or use the keyboard to type.
Signature field is empty.
Clear
Submit
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