ACT OF DONATION NICHOLLS STATE UNIVERSITY BE IT KNOWN, that on this Insert Date Number day of Insert Month in the year of Our Lord two thousand Insert yeart .(2015), Insert Donor Name and Address PERSONALLY CAME AND APPEARED (hereinafter referred to as “Donor”), who declared that in accordance of the educational work being carried on by the UNIVERSITY OF LOUISIANA BOARD OF SUPERVISORS, NICHOLLS STATE UNIVERSITY, herein represented by DR. BRUCE T. MURPHY, duly authorized to appear herein, (hereinafter referred to as “Donee”), do hereby irrevocably give, grant, confirm and donate, inter vivos, unto said Donee, the following described property, to wit: Insert detailed description of items donated And now DR. BRUCE T. MURPHY, in his capacity as a representative of the UNIVERSITY OF LOUISIANA BOARD OF SUPERVISORS on behalf of NICHOLLS STATE UNIVERSITY, do hereby accept said donation made to the UNIVERSITY OF LOUISIANA BOARD OF SUPERVISORS on behalf of NICHOLLS STATE UNIVERSITY and acknowledges due delivery and possession of the above described property. Donor estimates the total value of the property herein donated to be the sum of $Insert amount of donation – please be specific THUS DONE AND SIGNED this ___________________ day of_________________, 2015, at Thibodaux, Louisiana. WITNESSES: ____________________________ ____________________________ _____________________________ (DONOR) WITNESSES: ____________________________ ____________________________ (DONEE) Revised March 2015 NICHOLLS STATE UNIVERSITY _____________________________ Dr. Bruce T. Murphy