Library Item History Form Please enable JavaScript in your browser to complete this form.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 NameAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone/FaxEmail *Are you an MCHC member?YesNoDescription of materials and quantity/extentFor 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)? *PersonFamilyOrganizationName 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)?PurchaseGift or InheritanceFoundCreated by donor(s)Purchase - Please explain where and whenGift or inheritance - From whom and whenFound - Where and whenFurther information? Add any additional information you may haveHave you spoken to an MCHC staff member about your donation offer?YesNoName of MCHC stafferDo you have any reference material about the item(s) that we may reproduce?YesNoPlease 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 fitPlease return the object to meThank you for taking the time to provide this information. If you have questions please contact Library Staff at specialcollections@mdhistory.org Submit
