Wellesey Township Heritage and Historical Society


Donation Form

Name of Donor:_________________________________________________

Address:_______________________________________________________

Postal Code:__________________ Telephone Number: ______________

E-mail:___________________________________________________________________


Description of Object(s) Donated:

__________________________________________________________________

__________________________________________________________________


Object Information/ Historical Association/Related Stories:

__________________________________________________________________

__________________________________________________________________


I am the rightful owner or agent of the rightful owner of the object(s) listed above. I transfer, give, assign and deliver all rights, title and interest for the object(s) described above to the Wellesley Heritage and Historical Society (WTHHS) as an unrestricted gift.


Donor’s Signature:________________________________ Date:___________________


WTHHS Signature :________________________________ Date :___________________


Accession Number:_________________________