Monarch Butterfly & Memorial Specimen Intake Form

Customer Name: ________________________________________

Memorial Tribute ID: TRB-2026-________

Intake Date & Time: ________________________

Receiving Specialist: ________________________________________

1. Specimen Custody & Chain of Record

Item #	Specimen / Artifact Description	Condition at Arrival	Rehydration Requirement	Custody Verified
1	Monarch Specimen (Danaus plexippus)	[ ] Intact [ ] Partial [ ] Fragile	[ ] Standard Chamber [ ] Custom	[ ] Verified
2	Personal Memorial Keepsake / Note	[ ] Pristine [ ] Aged	[ ] Acid-Free Sleeve	[ ] Verified
3	Shadowbox Wood Frame / Enclosure	[ ] Selected: 8x10 Walnut [ ] Custom	[ ] Museum UV Glass	[ ] Verified

Digital Memorial Video / Audio: Uploaded to secure Supabase storage vault and linked to QR memorial medallion.

AR Butterfly Rigging Configuration: Selected Wing Motion Profile: [ ] Gentle Glide [ ] Vibrant Flutter.

Privacy & Public Sharing Preference: [ ] Private Family Only [ ] Public Community Memorial Gallery.

Verified By (Executive / Department Lead):

Printed Name / Title Date

Attested By (Accountable Participant / Employee):

Printed Name / Role Date