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Archives & Special Collections

Deed of Gift Form

PCOM Libraries and Archives Deed of Gift form in MS Word format.

Deed of Gift

Philadelphia College of Osteopathic Medicine

Libraries and Archives

DEED OF GIFT    

I, the undersigned Donor, hereby donate and convey to the Philadelphia College of Osteopathic Medicine (PCOM), for the benefit of the PCOM Libraries and Archives, all rights, title, and interest that I possess in the materials described in this Deed of Gift (the “Donated Materials”).

 

Donor Information:

Name: __________________________________ Phone: ____________________________

Address: ________________________________ Fax: ____________________________

________________________________________ E-mail: ____________________________

 

Nature of Donor’s Right in Materials (e.g. owner, heir, literary executor, trustee):

_____________________________________________

 

COPYRIGHT INTERESTS:

___ I represent and warrant that I control the copyright in the Donated Materials.

COPYRIGHT CONVEYANCES:

To assign to PCOM copyright in the Donated Materials, please initial here:

______________________.

 

 

 

 

 

 

 

 

Description of Donated Materials:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

I understand that the location, retention, cataloging, preservation, and disposition of the Donated Materials by PCOM will be conducted in its discretion, in accordance with PCOM’s policy and with applicable law. The Donated Materials may be displayed physically by PCOM. Images of the Donated Materials may be displayed on the World Wide Web in a manner reasonably assured to prevent copying or re-distribution. The Donated Materials shall be made accessible for research in accordance with PCOM Libraries and Archives policies.

 

SIGNATURE OF DONOR:

I represent and warrant that I am the sole owner of the materials described above; that I have full right, power, and authority to give the materials to PCOM; and that the information I have provided is accurate. The terms of this Deed of Gift shall apply to all of the Donated Materials described in this Deed of Gift notwithstanding that some materials may be delivered before or after the date of this Deed of Gift. I understand the sections on “Copyright Conveyances” and “Copyright Interests.” I have received an explanation of all terms and conditions of this Deed of Gift and agree to them as indicated by my signature below.

 

_______________________________________________________

 

Date: ___________________

 

ACCEPTANCE BY PCOM:

 

PCOM Libraries and Archives hereby accepts this gift with appreciation and agrees to the conditions stated in this Deed of Gift.

 

_______________________________________________________

 

Date: ___________________

 

Name: __________________________________

 

Title: __________________________________