Bureau of Land Management



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Bureau of Land Management







(State/District/Field Office)




BLM Verification of Collections

(completed by BLM)

Address




BLM Official:




City, State, Zip Code




Date Received:




REPOSITORY RECEIPT FOR COLLECTIONS
Artifacts and specimens recovered from BLM-administered lands are Federal property, and must be managed in a manner consistent with Federal stewardship responsibilities for museum collections. Cultural or paleontological resource permits for collecting activities require that the permittee arrange for curation of artifacts and specimens in an appropriate repository. Collections must be deposited in a repository for curation within one year of completion of the permitted project, unless alternate arrangements have been approved by the BLM permitting official.
This Deposition of Museum Collections Confirmation and Inventory form is required as a condition of the permit and must be completed for all museum collections originating from BLM administered lands, with the associated documentation, to ensure collections are deposited in an appropriate curatorial facility. A receiving document generated by the repository may be substituted if it contains the same information as this form.

Instructions


  1. All information requested on this form must be completed by the permittee and repository officials.

  2. Permittees must provide an itemized inventory of the objects, lots, samples, and associated documentation to be deposited attached to this statement. The inventory must include site or locality designation, number of units per material type according to BLM and the repository standards. A complete collection includes:

  1. A repository official must acknowledge receipt of the collection. Before signing, the repository official should compare the inventory to the actual objects and records being deposited.

  2. If the permittee and the Repository Official are the same individual, an additional Repository Official must be signatory to this form.

  3. After this form has been signed by the repository official, the original form with the collection inventory must be submitted the BLM State Archaeologist by the permittee.

  4. Upon submission to BLM, the BLM official may contact the repository to verify the inventory of collections deposited by the permittee.



Permittee Information





Permit Number:




Project Name and Number:







Permittee Name:







Address:







City, State Zip Code:







Telephone Number:



Certification of Collection Deposition in Repository by Permittee





I,_________________________(Permittee) certify that __________________________(name of repository) has on this date, _____________,

accepted the collections of objects, lots, samples, and associated documentation described on the attached inventory.






Signature:




Date:







Complete or Partial Deposit (check one)










I certify that the inventory represents all materials and associated documentation from the work performed under this permit (complete deposit).







I certify that this represents a portion of the materials and associated documentation. The attached sheet lists what materials are not yet deposited, the reason they are not deposited at this time and when they are expected to be deposited (partial deposit).

Curation Facility Information





Repository Name:







Address:







City, State Zip Code:







Telephone Number:







Official Authorizing Receipt (name and title):







Accession Number Assigned by the Repository:



Receipt of Collection Statement by Repository Official




I, ___________________________ (Repository Official) certify that the ________________________________(name of facility) has on this date,____________, accepted the collections of objects, lots, samples, and associated documentation described on the attached inventory from ________________(permittee).







Signature:




Date:





Bureau of Land Management

COLLECTION INVENTORY FORM




Permit Number:







Repository Name:




Discipline:




Archaeology

Repository Accession Number:




(check one)




Paleontology




Site or Locality

Number

Catalog Numbers

or Field Specimen Numbers



Material Type

Quantity


Unit Type

object, bag, cubic feet, linear feet,



other (specify)

Comments














































































































































































































































































































































































TOTAL ITEMS:






Objects

Bags (lot)

Cubic Feet (lot)

Linear Feet (archival lot)










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