Department of Justice
Gift Donation Form

Please complete this form prior to the delivery or presentation of your gift.

Send this completed form to:  Property Management Services
                                             Facilities and Administrative Services Staff
                                             Department of Justice
                                             National Place Building, Suite 1070
                                             Washington, DC 20530


The following gift is offered to the U.S. Department of Justice:
__________________________________________________________
(Description of Gift)

If non-cash, the value of the gift is estimated at $______________________
Note: This is the donor's estimate. The Department of Justice does not confirm or endorse this as the value of the gift,
nor make any representation of the value of this gift for any tax purposes.

This gift may be used:

______ For any purpose, or

______ Only for the following purpose:

The donor must indicate below any matters pending or likely to arise in the future that might involve the Department of Justice. Please consider all individuals or members of an organization (if applicable) involved in the donation of this gift.

____________________________________________________________
(Describe pending matters or matters likely to arise)

I understand that this property is given as a gift to the Department of Justice and will become Government property. I understand that this donation is irreversible, and that I retain no personal rights of use, ownership, or possession.

Donor: ______________________________  Phone: __________________

Full Address:  __________________________________________________

____________________________                  __________
(Signature)                                                          (Date)

I have determined that this gift is appropriate for use by or display within the component. This gift was not solicited.

__________________________________________________________________
(Name and Signature of Component Head or designee)                         (Date)

Concurrence by component Deputy Designated Agency Ethics Official (DDAEO):

_____________________________________________________________________
(Name and Signature of DDAEO)                                                                  (Date)

3/18/99