Loan of Materials Form

Loan of material to the Collins Regional Historical Society

I own, or have legal authority over the materials described below:

…and voluntarily loan the item(s) to the Collins Regional Historical Society as a donation.

It is distinctly understood that the purpose and intention of this loan is to allow the Collins Regional Historical Society to make these materials publicly accessible.

The Collins Regional Historical Society will display the item(s) at

From (date): ________________ To (date): _____________________

…returning the item(s) to its owner at the conclusion of this period.

As the owner of this item(s), I understand that the Collins Regional Historical Society will act in good faith to protect the item(s) while it is under their guardianship and will not hold the Collins Regional Historical Society liable for any inadvertent damage which may occur while in the custody of the society.

Loaned by: (Print) ______________________________ (Date) _____________

Address: __________________________ Town: __________________________

State: _____________ Zip Code: ________________ Telephone: _____________

Signature of Loaner: ___________________________________

Received by: _____________________________________ Date: ____________

Collins Regional Historical Society