2. Wyoming County Historian's Office

   Phone:(585) 786-8818 Email: kproper@wyomingcountyny.gov

   Donation Form

4. Type of Donation:

   1. Digital Donation
   2. Physical Donation
6. Donor:
7. Date:
9. Address:
11. Phone:
12. Email:
14. Description of Items (Please give as much detail as possible):

16. By e-signing below, I hereby donate the above-described item(s) to the Wyoming County Historian’s Office. I certify that I own said item(s) and have the legal right to make this donation. As the owner/agent with full authority, desiring to absolutely transfer full title of the item(s) by e-signing below, I hereby give, assign, and convey, finally and completely, without any limitation, condition, or reservation, the item(s) described above to the Wyoming County Historian’s Office and its assigns, permanently and forever, together with (when applicable) any copyrights therein and the right to hereafter copyright the same. I fully understand that I will not receive compensation in connection with my donation.

18. Electronic Signature

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

20. (E-Sign)

    1. I Agree
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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