Faculty Member: I, the undersigned, have assessed the gift- or gifts-in-kind referenced above and hereby state that these items have educational, research, or clinical value to my unit..
Trang 1Gift-in-Kind Form
Donor Name: _ Contact Name (if organization representative): _ Address: _ Phone: Email: _ Tax ID or Social Security No.: _
Recipient Unit: _ Contact Name in Recipient Unit: _ Address: _| _ Phone: Email:
Description of Gift-in-Kind: _ Intended use of Gift-in-Kind: Location on/off campus of Gift-in-Kind: _
No
No
If new product, documentation from donor of value included? Yes
If used product, independent third party appraisal completed? Yes
Overall Appraised or Market Value: $ _
Please attach itemized appraisal
or market value documentation
Faculty Member:
I, the undersigned, have assessed the gift- or gifts-in-kind referenced above and hereby state that these items have educational, research, or clinical value to my unit If accepted by Stony Brook University, the gift- or gifts-in-kind will be used to advance the university’s mission
_ _
Print Name Signature Date
Dean or Provost:
On behalf of School or College _, I endorse the acceptance of the gift- or gifts-in-kind referenced above
_ _
Print Name Signature Date
Once completed, please forward this form and supporting documentation
to:
Central Services Property Control Office
Stony Brook University
100 Nicolls Road
Stony Brook, NY 11794-6950
P: (631) 632-6348
E: louise.melious@stonybrook.edu
Donor:
I, the undersigned, hereby absolutely, irrevocably and without restriction give, transfer, and assign to Stony Brook University all rights, titles, and interests in, to, and associated with the gift-in-kind described above I affirm that I own said object and that to the best of my knowledge I have good and complete right, title, and interests to give _ _
Print Name Signature Date