Allan McCollum hereby donates to ___________________________
a topographical model of the state of Kansas [or Missouri] to be used and/or disposed of at it's unrestricted discretion, and hereby waives all future claims on the object or rights over its use or disposition.

Agreed to by:

Allan McCollum

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____________________________ hereby receives and accepts from Allan McCollum the gift of a topological model of the state of Kansas [or Missouri] in "as is" condition, and hereby agrees to hold Mr. McCollum free of all liability for any damages that may result from any use or misuse of the object; we also understand and hereby agree and acknowledge that Mr. McCollum makes no warranty as to the durability of the object or to the safety or functionality of it's hanging hardware.

Received and agreed to by:

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(PLEASE PRINT)                               DATE

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