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Fine Art Provenance

Subject's Name*:
Donor's Name*:
Donor's Street*:
Donor's City*:
Donor's State*:
Donor's Zip Code*:
Donor's Phone*:
Artist's Name*:
Date Created:
Type of Art  
If other type here:
Materials Used:
Value of Piece:
Date Donated:  [None] Select a Date Delete the Date
Date Received:  [None] Select a Date Delete the Date
Location of Piece:  
Name and Dept. of Person Filling Out Form:  
Email of Person Filling Out Form:
Date form given to Carpenter Library/Archives:  [None] Select a Date Delete the Date
Additional Comments:  



Quick Reference

Dorothy Carpenter Medical Archives
E Floor - Gray Building

Archives 336-716-3690

Open by appointment.
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