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GIFT AGREEMENT AND RECEIPT <br /> I(we) own the materials described on the reverse and attached pages, and voluntarily gift and <br /> devise them to the City of Centerville as a donation. It is distinctly understood that the purpose <br /> and intention of the donation is to permanently transfer and grant all such rights, title, and <br /> interest I(we)possess in these materials to the City of Centerville. Artifacts given will be added <br /> to the City of Centerville's historical collections to be used to honor Centerville's rich history and <br /> heritage. <br /> Donor Name(s) <br /> Address <br /> Phone Email <br /> Donated item description (please describe each item): See attached list <br /> Donor's estimate of value (for tax declaration purposes <br /> only) <br /> Name as it should appear on Credit line, if the items are exhibited or published: <br /> City Initiated Return of Items <br /> Should City of Centerville determine that any item will not be kept in the collection, but will be <br /> in any way permanently transferred to another entity or individual, then City of Centerville will <br /> give Donor representative named here (or on a list maintained by the city clerk, updated at the <br /> sole responsibility of the Donor and their heirs) not less than 30 days written notice of its <br /> intention to transfer ownership to another. Donor representative will have the opportunity within <br /> that notice period to request return of the item. The item may be picked up or at request of <br /> Donor, shipped to an address indicated by Donor, then Donor shall pay costs of shipping. <br /> Donor Notice to be given to (up to two names): <br /> Name <br /> Address <br /> Phone <br /> S:\Forms\GIFT AGREEMENT ANDRE CE I PT Donated Artifacts MRS version 2018-01-05.docx <br /> 37 <br />