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