Museum Donation Inquiry Form/Object History Form / Museum Donation Inquiry Form/Object History Form Museum Donation Inquiry Form/Object History Form Please enable JavaScript in your browser to complete this form.Donor's Name *FirstLastToday's DateAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *PhoneFaxAre you a MCHC member?YesNoIf no, would you like to join?YesNoObjectUpload image(s) of object here: Click or drag files to this area to upload. You can upload up to 5 files. Please indicate height, length/width, depth and material of objectWas this object made, used or found in Maryland?MadeUsedFoundN/AName of person most associated with this objectFirstLastThis person is the:OwnerUserMakerThis person's addressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeThis person's place of birthThis person's year of birthThis person's place of deathThis person's year of deathThis person's place of residenceThis person’s work, place of work and datesThis person’s membership in organizations (church, etc.) or other positions or activities in MarylandDescribe your relationship to this personHow did you obtain this object?PurchaseGift/InheritanceFoundWhere and when did you obtain this object?From whom and when did you obtain this object?If you know of any other owners or users of this object, please list themDo you have a photograph of the owner, user, maker, or object that we may reproduce? YesNoCan you tell us more about the maker, date made, maker’s location, or any other information about the maker?How was this object used? Please describe it's place or dates of use as well as how it worked or any unusual features. Does anyone else have information about the object or its owner or maker? If so, who?Is there further information you would like to include?Have you spoken to a MCHC staff member?YesNoIf yes, who?FirstLastDo you have any reference material about the object that we may reproduce? YesNoIf we don’t want this object: Dispose of as the curator sees fitPlease return the object to meSubmit