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4746 Gravois Avenue
St. Louis, MO 63116
(314) 832-7790


Donor/Seller Name__________________________________________________________________




In accordance with the CONDITIONS shown on Page 2, the object(s) listed below are acquired by the Miniature Museum of Greater St. Louis.

Number                                                               Description






Include as much information as possible pertaining to the creator, date made, special pieces, antique, electrified, dimensions, scale, etc.  Attach additional sheets is needed.

I hereby covenant that I am the lawful owner of the personal property, goods, and chattel herein described; that they are free from all encumbrances; that there has been no prior pledge, option, or gift of any part hereof and I have the right to give or sell the same as aforesaid; that I will warrant and defend the title thereto against lawful claims and demands of all persons.

Having read and understood the CONDITIONS listed on this agreement and the COLLECTIONS POLICY listed on Page 2, by this instrument, I hereby Convey and Warrant (as an unconditional and irrevocable gift or in consideration of the payment referred to below) the above described "Acquisition" together with all gift or in consideration of the payment referred to below) the above described "Acquisition" together with all Copyrights, Trademarks, and Associated Rights pertaining thereto to the Miniature Museum of Greater St. Louis.

Signature of Donor/Seller_______________________________________________________Date_______________________


Acquisition is Donated.   Donor's name may be used in:  (please circle choice)

Publicity about this gift:             Yes           No                    Exhibit captions/catalogs:            Yes             No

Receipt of above material is hereby acknowledged with appreciation for and in behalf of the Miniature Museum of Greater St. Louis

Museum Representative Signature__________________________________________Date______________________



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