Name of Owner ________________________________________________________

Address ______________________________________________________________

City & State/Province ________________________________________________

Country __________________________  Preferred Language _______________

Object(s) are located in _____________________________________________

Purpose of Appraisal (e.g. gift, estate, insurance, etc.)
 
           ___________________________________________________________
For charitable donation:

    Date of Donation ____________  Recipient institution ____________________



DESCRIPTION OF OBJECT (Please attach a photograph of the item & use a separate sheet for each object)

What is the Object __________________________________________________

Place of Origin ___________________________________________________

When was the object made ___________________________________________

Of what materials is the object made __________________________________

Dimensions (inches/cm.) Height: _______/________ Width: ______/_______

                        Depth: ______/_______

Condition  _______________________________________________________

Restoration ______________________________________________________

Provenance, including dealers ______________________________________

Notes of Publication & Exhibition, if any _____________________________________

Additional Comments