CERTIFICATE OF GIFT

The undersigned, being the owner, hereby gives, delivers, and transfers to LSUS Archives and Special Collections the following item(s), to wit:








to be used by said Archives as a part of its historical collections for exhibition and for research and reference by historians, students, faculty, and the scholarly public. Said archives is granted all rights and title thereto, including copyright and literary rights, which owner may have or may be deemed to have, and shall have the right to determine what use and disposition shall be made of said item(s), subject to the following stipulations and conditions:

The above described materials shall be permanently established and known as  ____________________________________________ and shall be administered in accordance with the policies and practices of LSUS Archives and Special Collections.

In return LSUS Archives and Special Collections agrees to house, preserve, and exercise reasonable care in the use and storage of the said item(s).

Dated at __________________________, this ____ day of __________________, 20___.

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Signature of donor

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Signature of LSUS Representative

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Witness

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Witness