AGURI HERITAGE — CONTRIBUTION RECORD

Title or short description:
Type of item (photograph / letter / journal / oral history / other):
Date or approximate date (state how it is known):
Place (historical name and present-day location if known):
Names of people shown or mentioned (with evidence for identification):
Owner / holder of the original:
Contributor:
Source / provenance (how the item came to you):
Printed page or journal volume / issue where applicable:
Suggested correction or information this adds:
Uncertain words, names or dates:

Permission to publish the item:
Permission to publish names / identifying details:
Credit line requested by the owner:
Restrictions, redactions or conditions:

Keep this record with the original item or a faithful scan. Do not alter or
write over the original. This template is a local document, not a submission
form, and sends no information to the project.