Library Item History Form – Maryland Center for History and Culture

Item History

We’d like to learn as much as you can tell us! To better fulfill our mission, the Maryland Center for History and Culture needs as much information as possible about the history of the materials it collects and how they relate to Maryland history. Please complete this form and provide any reference photos that you can.

Donor's Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone/Fax

Email *

Are you an MCHC member?

Yes
No

Description of materials and quantity/extent

For quantity/extent, please provide us with a number of items (for a small collection) or a number of containers i.e., 5 record carton boxes.

Who was most associated with the creation of the material(s)? *

Person
Family
Organization

Name of the person most associated with the item(s)

Person's biographical information (birth and death dates, place of residence, occupation, etc.)

Name of the family most associated with the item(s)

Family history (names, date, locations, etc.)

Name of the organization most associated with the item(s)

Organizational history (as much background as you can provide on people involved, dates of existence, type of organization, etc.)

How did you obtain the item(s)?

Purchase
Gift or Inheritance
Found
Created by donor(s)

Purchase – Please explain where and when

Gift or inheritance – From whom and when

Found – Where and when

Further information? Add any additional information you may have

Have you spoken to an MCHC staff member about your donation offer?

Yes
No

Name of MCHC staffer

Do you have any reference material about the item(s) that we may reproduce?

Yes
No

Please use the upload field for: Reference photographs / Any documents that provide more information / Useful diagrams / Family genealogy with names / Family stories / Anecdotes

Click or drag files to this area to upload. You can upload up to 5 files.

If we don’t want the item(s)

Dispose of as staff sees fit
Please return the object to me

Thank you for taking the time to provide this information. If you have questions please contact Library Staff at specialcollections@mdhistory.org