ARCHIVE FORMS Donor Agreement and Deed of Gift


Pine Mountain Settlement School Archives & Collections
36 Highway 510, Pine Mountain, Kentucky 40810
Ph: 606-558-3571

I, __________________________________, DONOR, sole and absolute owner of these materials, give to the PINE MOUNTAIN SETTLEMENT SCHOOL, Harlan County, Kentucky, the following item(s) (attach an additional list of materials if necessary):



This donation has been received by PINE MOUNTAIN SETTLEMENT SCHOOL as a gift for use in their collections. Permission is hereby given by the owner or his agent with full authority, desiring to absolutely transfer full title by signing below. The DONOR hereby gives, assigns, and conveys finally and completely, and without any limitation or reservation, full and complete ownership of the property described above to PINE MOUNTAIN SETTLEMENT SCHOOL and its successors and assigns permanently and forever, together with any copyrights therein and the right to copyright the same. Any limiting conditions or exceptions to this agreement are listed below:

Limiting conditions:



In witness whereof I have hereunto set my signature this ___ day of ___________, 20_____

Donor’s signature: ______________________________________________

Donor’s printed name: __________________________________________

Donor’s address: ________________________________________________


Donor’s e-mail:  _________________________________________________

Donor’s phone:  _________________________________________________

Signature of Pine Mountain Settlement School Representative:


Printed name of Pine Mountain Settlement School Representative:

______________________________________________________________ Date: _________________