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LenderCopy <br />Loan#:________________ <br />Loan Form <br />Name: ____________________________________________________ Date: _____________________ <br />Address: ______________________________________________________________________________ <br />______________________________________________________________________________________ <br />Phone: ____________________________________ Email:________________________________ <br />On __________, the City of Centerville, a city in Anoka County located at 1880MainStreet,Centerville,MN55038 <br />(hereinafter “Centerville”), enter into an agreement with ___________________________________ <br />(hereinafter “Lender”) as follows: <br />The Lender, to the best of his/her knowledge, has all rights, title, and interest of the artifact(s) without <br />restriction of any nature. The Lender wishes to loan the artifact(s) to Centerville for the specified peri- <br />od of time, for the stated purpose(s). <br />Centerville and the Lender agree that: <br />1. The artifact(s) described below will be loaned for display at the City Hall in the display case <br />(DescriponofLoanItems) <br />2. The artifact(s) will be loaned to Centerville from ______________to ________________ <br />OR <br /> for the duration of ___________________________________________________. <br />3. Centerville will return the loaned artifact(s) in the same condition they were received in, ORonly with <br />changes approved by the Lender. <br />4. The Lender agrees that they are responsible for picking up the loaned artifact(s) within 30 days after the <br />duration of the loan has expired. Centerville will inform the Lender when the artifact(s) are ready to be <br />picked up. <br />5. Centerville has the right to share images of the artifact(s) for promotional and event purposes. <br />6. Centerville will not use, transfer, or display the artifact(s) except as previously agreed upon and included <br /> with this document. <br />By my signature below, I accept the forgoing conditions and acknowledge reading any attached information. <br />\[ĻƓķĻƩ {źŭƓğƷǒƩĻʹ ________________________________________5ğƷĻʹ _______________ <br />CentervilleStaSignature:_________________________________Date:_______________ <br />PrintName:___________________Title:__________________ <br /> <br />