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[[preprinted form with lines and boxes around each section]] U.S. DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS - OFFICE OF INTERNATIONAL TRADE SHIPPER'S EXPORT DECLARATION OF SHIPMENTS TO FOREIGN COUNTRIES OR NONCONTIGUOUS TERRITORIES OF THE UNITED STATES Form 7525-V (Rev. Nov. 1948) EXPORT CONTROL FOREIGN COMMERCE STATISTICAL REGULATIONS (See Instructions on Reverse Side) READ CAREFULLY THE INSTRUCTIONS ON BACK TO AVOID DELAY AT SHIPPING POINT Clearance shall not be granted until shipper's declaration has been filed with the Collector of Customs. This declaration shall not be used to effect any exportation after the expiration date of the export license referred to herein, except as specifically authorized by export regulations. DECLARATIONS SHOULD BE TYPEWRITTEN OR PREPARED IN INK; INDELIBLE PENCIL IS NOT PERMISSIBLE. Do Not Use This Area [[blank]] District [[blank]] Port [[blank]] Country (For customs use only) [[blank]] 1. EXPORTING CARRIER (if vessel, give name, flag and pier number) [[blank]] 2. FROM (U.S. Port of Export) ^[[New York]] 3. EXPORTER (Principal or seller - licensee) ^[[JACQUES SELIGMANN & CO., INC.]] ADDRESS (Number, street, place, State) ^[[5 East 57th Street New York 22, N,Y.]] 4. AGENT OF EXPORTER (Forwarding agent) ADDRESS (Number, street, place, State) [[blank]] 5. PURCHASER OR ULTIMATE CONSIGNEE ^[[CHRISTIE, MANSON & WOODS, LTD.]] ADDRESS (Place, country) ^[[6 King Street St. James's LONDON SW1,England]] 6. INTERMEDIATE CONSIGNEE ADDRESS (Place, country) [[blank]] 7. FOREIGN PORT OF UNLOADING (For vessel and air shipments only) ^[[LONDON (ENGLAND)]] 8. PLACE AND COUNTRY OF ULTIMATE DESTINATION (Not place of transshipment) ^[[LONDON]] 9. MARKS AND NOS. ^[[J S - I]] 10. NUMBER AND KIND OF PACKAGES, DESCRIPTION OF COMMODITIES, EXPORT LICENSE NUMBER, ISSUANCE DATE, EXPIRATION DATE (or General License Symbol) (Describe commodities in sufficient detail to permit classification according to Schedule B. Do not use general terms. Insert required license information on line below description of each item) ^[[17 lots drawings & tracings by J.L. DAVID]] 11. SHIPPING WEIGHT* (Gross weight in pounds) Not required for truck, rail, and mail exportations) ^[] 12. SPECIFY "D" OR "F" [[superscript]]¢[[/superscript]] ^[[F]] 13. SCHEDULE B COMMODITY NO. ^[] 14. NET QUANTITY IN SCHEDULE R UNITS (State unit) [[blank]] 15. VALUE AT TIME AND PLACE OF EXPORT (Selling price or cost if not sold, including inland freight, insurance and other charges to place of export) (Nearest whole dollar; omit cents) ^[[$1,500.]] 16. WAYBILL OR MANIFEST NO. (of Exporting Carrier) [[blank]] 17. DATE OF EXPORTATION (if Vessel, Date of Clearance) [[blank]] 18. THE UNDERSIGNED HEREBY AUTHORIZES [[blank]] TO ACT AS FORWARDING AGENT FOR EXPORT CONTROL AND CUSTOMS PURPOSES. (Name and address - Number, street, place, State) EXPORTER [[blank]] BY (DULY AUTHORIZED OFFICER OR EMPLOYEE) [[blank]] 19. I DECLARE THAT ALL STATEMENTS MADE AND ALL INFORMATION CONTAINED IN THIS EXPORT DECLARATION ARE TRUE AND CORRECT. 20. Subscribed and sworn to before me on [[blank]], 19 [[blank]] SIGNATURE (Duly authorized officer or employee of exporter or named forwarding agent) [[blank]] FOR (Name of corporation or firm and capacity or signee, e.g. secretary, export manager, etc.) [[blank]] ADDRESS [[blank]] (TITLE OF DESIGNATION) Notary Public, etc., or those authorized to administer oaths under Sec. 486, Tariff Act of 1930. Declaration should be made by duly authorized officer or employee of exporter or of forwarding agent named by exporter. * If shipping weight is not available for each Schedule B item listed in column (13) included in one or more packages, insert the approximate gross weight for each Schedule B item. The total of these estimated weights should equal the actual weight of the entire package or packages. ¢ Designate foreign merchandise (reexports) with and "F" and exports of domestic merchandise produced in the United States or changed in condition in the United States with a "D". NO AUTHENTICATED DECLARATION RELATING TO ANY COMMODITY REQUIRING AN EXPORT LICENSE MAY BE ALTERED, CHANGED OR AMENDED WITHOUT PRIOR WRITTEN AUTHORIZATION FROM THE COLLECTOR OF CUSTOMS OR FROM SUCH OTHER PERSON AS MAY BE EMPOWERED BY EXPORT REGULATIONS TO GIVE SUCH SRITTEN AUTHORIZATION. (See also Instruction 2 (e).) Do Not Write in This Area [[/preprinted form]]
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