(Contact) 

RE:	  Proposed Donation of Personal Property/Equipment
DATE:     

I.	Current Ownership (full name and address of owner/donor):

          Name:     
          Company:  
          Address:  
                    
          Telephone: Fax:  

II.	Description of Property:

         Check the type of property being considered for donation
             	1. Artwork
             	2. Collection of Books or Periodicals
             	3. Research-Related Equipment or Supplies
             	4. Equipment or Supplies for Instructional Purposes
             	Other:
          

         For items in categories 1 or 2, complete all but sections IV and VI. For
         items in categories 3 and 4, complete all sections. For "other" items,
         call the Development Office (277-6543) for appropriate instructions. 

         List below (or on attached pages) all items of equipment or other
         personal property proposed to be donated in as much detail as possible,
         including, but not limited to, such information as manufacturer, brand
         name, make, model, year of manufacture, size, and estimated fair market
         value.
          

         Has a representative of the University inspected the property?Yes No
              If so, give the name and title of the inspector:
              
         Also, describe the condition of the property (e.g. mint/new/used/
         well-used) and any specific concerns raised at inspection:
         
         How is/was the property used by current owner/donor?
          

III.	Title Information:

         Is the owner/donor the manufacturer or artist? Yes No
         How did owner/donor acquire this property? 
         
         How long has owner/donor owned this property?
         If applicable, has a provenance been obtained?Yes No
              If so, please provide a copy of the report.
         Does the owner/donor wish to retain an interest in the property (e.g.
         physical possession, proceeds from copyrights and/or royalties)?
         Yes No
              If so, please describe terms and conditions:
          

IV.	Financial Information: 

         Is there a recent appraisal of the property?Yes No
              If yes, give date and appraised value $and
              name and address of appraiser
              
              Please provide a copy of the appraisal.
         Are there any existing liens or security interests against this property?
         Yes No
              If so, please describe:
         
         Has there been a UCC chattel search relating to this property?Yes No
              If so, please attach a copy of the report.
         Is there pending litigation relating to this property?        Yes No
              If so, please describe:
         
         Are there any insurance claims made with regard to the use of this 
         property?Yes No
              If so, please describe:
         
         Has the property been the subject of any regulatory designations?
         Yes No
              If so, please list type of designation and regulatory agency:
         

V.	Acquisition:

         Where is this property currently located? 
         
         How is the property to be delivered to the University?
         
         Is delivery to be at owner/donor expense or University expense?
              If delivery is at University expense, give the estimated
              total cost: $
              Provide the projected source(s) of payment of such expenses:
         
              Please obtain signature below from authorized signatory on this
              account.

VI.	Environmental and Contractual Issues:

         Does the property require review and approval by Risk Management for
         health or safety concerns as provided for under Section 4 of UBP
         POLICY 7110 "Gifts of Tangible Personal Property"?    Yes No
              Please obtain the appropriate signature from the Office of Risk
              Management at the bottom of this form or attach assessment or
              report, if necessary.
         Is this donation governed by a contract currently on file with the
         University?  Yes No
              If so, attach a copy of the related contract, or provide a 
              description of the contract (including parties to and date of
              contract):
         
         Does donor require a new contract to be signed relating to this gift?
         Yes No
                 If so, please complete and attach the Contract Review Form Exhibit C.
         of "Contracts Signature Authority and Review Policy", Policy 2010, UBP.
         
         Does the new or existing contract include and indemnification clause?
         Yes No
         If so, describe extent of indemnification and whether or not the
         donation will be covered by the University's contractual liability
         insurance:
         
              Please obtain the appropriate signature from Risk Management
              indicating that the property can be insured through the
              University's contractual liability insurance and attach
              supporting documentation, if necessary.

VII.	Disposition:

         How does the department/program intend to utilize the property?
         
         Does the owner/donor have any requests regarding disposition of the
         property? 
         Yes No 
              If so, explain the request(s) and how the department/program 
              intends to meet these request(s):
         
         Where will the property be located? 
         
         Will there be costs associated with initial installation of the property?
         Yes No
              If so, give the estimated total cost: $(attach detailed 
              explanation) Provide the projected source(s) of payment of such 
              expenses:
          
          Will there be costs associated with ongoing maintenance of the property?
          Yes No
             If so, give the estimated total cost: $(attach detailed
             explanation) Provide the projected source(s) of payment of such
             expense:
          
          Please obtain signatures below from authorized signatories on these
          accounts. Also, please note that, depending on the estimated cost of
          installation and maintenance, approval of the Regents or the University
          Administration my also be required per Regents'
          Policy 7.13 "Receipt and Investment of Gifts to the University."

VIII.	Supporting information available:

Please attach all other information which will help UNM evaluate the property:
          Contracts	                 Contract Review Form	 Appraisal(s)
          Lien documents	         UCC Chattel Search	 Inventory List
          Risk Management Assessment	 Photographs	         Provenance
          Other (please list): 
           

Additional Comments:

           

SUBMITTED BY:

Signature of Contact:_______________________________________________________________

Printed Name and Title:_______________________________  Date: ______________________

Department/Program: ________________________________________________________________ 

Signature of Contact:_______________________________________________________________

Printed Name and Title:_______________________________  Date: ______________________

Department/Program: ________________________________________________________________

APPROVED BY (check all that are applicable)

 RISK MANAGEMENT DEPARTMENT (as to environmental assessment and/or
                                as to contractual liability insurance coverage)

Signature of Contact:_______________________________________________________________
Printed Name and Title:_______________________________  Date: ______________________

 OTHER (If any of the accounts from which expenses relating to this property
are to be paid require signature of an individual other than the Department/
Program contact and/or the Dean/Director//Vice President who submitted this
document, please indicate approval by signature(s) below)

Signature of Contact:_______________________________________________________________

Printed Name and Title:_______________________________  Date: ______________________

Signature of Contact:_______________________________________________________________

Printed Name and Title:_______________________________  Date: ______________________