Object Information Form

Please tell us about the person most associated with this object (the maker/artist, original owner etc.)
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Place of Birth *
Year of Birth *
Place of Death *
Year of Death: *
Place of residence: *
Occupation *
Place of Business and dates: *
This person's community involvement (memberships in organizations (church, etc.) or other positions or activities in York County, Pennsylvania: *

How did you obtain this object?
Choose 1 option *
Please give us details as it relates to your answer above - Where?, When? From whom? *
Previous owners, users and dates, if known?
If you know of any other owners or users of this object, please list them. *
Do you have an image of the owner, user, maker, or object that we may reproduce? *

Yes No
Maker: *
Location made? *
Date Made *
Makers background: *
How was the object used? *
Location of use: *
Dates of use: *
Describe how it worked or any unusual features: *
Does anyone else have information about the object or its owner or maker? *
Have you spoken to a York County History Center staff member? If so, who? *
Do you have any reference material (manuals, photographs, newspaper articles) about the object that we may reproduce? *

Yes No
If necessary, please tell us more information you may have, such as useful diagrams, family genealogy w/names, family stories, anecdotes, etc. *

I HAVE LEGAL TITLE TO THE ABOVE OBJECTS *

YES NO
I INTEND TO DONATE THE ABOVE OBJECT(S) TO THE YORK COUNTY HISTORY CENTER PENDING THE APPROVAL OF THE COLLECTIONS COMMITTEE. *

YES NO
Owner's Signature *

Clear
Today's Date *

Month Day Year
Date
You may upload up to six image files. Maximum size per each image is 10MB. We can except the following file types: .pdf, jpg, jpeg, png, gif.

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OBJECT INFORMATION FORM