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CITY OF OSHKOSH DONATION FORM
(for gifts and donations $100, or more)
1) Hereby gives the City of Oshkosh (choose Dept/Division): POLICE FIRE SR CTR PARKS/FORESTRY COMM DEV ________
DONOR INFORMATION
Organization or Name:____________________________Address:___________________________________________________
Phone:_________________________________________Email:_____________________________________________________
Personal Property:_______________________ Valued at: $__________for the purpose of:____________________________
Equipment:_____________________________ Valued at: $__________for the purpose of:____________________________
Materials:______________________________ Valued at: $__________for the purpose of:____________________________
Description of Service:____________________ Valued at: $__________for the purpose of:____________________________
Other non-monetary gift:__________________ Valued at: $__________for the purpose of:____________________________
Real Property Address:__________________________________________ Assessed or Appraised value: $________________
*Attach a description including type of property (residential, vacant land, land with structures, etc), conditions affecting
the value of the property (environmental, zoning, other restrictions, etc), maintenance costs, and any other relevant info.
Memorial:___________________________________________________________________Cost: $_____________________
Tribute:_____________________________________________________________________Cost: $_____________________
Work(s) of Art:_______________________________________________________________Cost: $_____________________
Public Improvement Project or Proposal:_________________________________________ Cost: $_____________________
*For all the above, attach a description to include the purpose of the donation (or intent of the proposal), cost estimates, size,
proposed location, timeline, site drawing, type of materials, intended lifespan, future maintenance requirements and costs,
and any other relevant information.
⃝ CASH OR CHECK in the amount of: $________________for the purpose of:_____________________________________
or choose category below and if more space is needed for descriptions please attach a separate paper:
2) This Donation is subject to the following restrictions/conditions (if any):_____________________________________________
3) Will a Donor Recognition Object be requested as part of this gift/donation? YES NO If so, please attach description.
4) The City of Oshkosh will make reasonable efforts to accommodate the intended purpose of the donation, but reserves the
right to utilize, relocate, and/or dispose of any item or property (including items funded by donated funds) as the City deems fit.
5) All rights, title, and interest in the above stated item(s) or property is hereby given, donated, and transferred to the City of
Oshkosh, its successors and assigns forever and without limiting conditions, except as may be specifically stated herein. It is
understood and agreed that I/we Donor(s) retain no right, title, or interest in the donated item(s) or property.
6) To the best of our knowledge, this gift/donation is free and clear of all encumbrances and restrictions.
__________________________________________________________________________ _________________________
DONOR Signature(s) Date
______________________________________________ _____________________________________________________
DEPARTMENT HEAD Signature (required) CITY MANAGER Signature (required for donations $500, or more)
__________________________________________________________________
DATE Reviewed and Accepted By COUNCIL (if required)
Department/Division Use Only: Revenue Acct #__________-4952-___________Expense Acct #___________________________
*****SEND A COPY OF THE COMPLETED DONATION FORM (WITH ATTACHMENTS) TO THE FINANCE OFFICE*****