Viewing page 8 of 97

This transcription has been completed. Contact us with corrections.

Form FFC 168
Treasury Department
FOREIGN FUNDS CONTROL

[[underline]] REPORT [[/underline]]

[[underline]] (This report must be executed in duplicate and attached to application Form TFE-1 under the provisions of T. D. 51072, relating to the release of art objects from customs custody.) [[/underline]]

1. (a) Entry No.:
   (b) Port of entry:
   (c) Date of importation:
   (d) Country of export:
   (e) Date of export shipment:

2. Description of art object -
   (a) Category (painting, sculpture, ceramics, etc.):
   (b) Title of work, if any:
   (c) Material composition:
   (d) Dimensions (without frame, mat, or pedestal, etc.):
   (e) Name of foreign country in which art object was created:
   (f) Name of artist or craftsman:
   (g) Approximate date of work:
   (h) Distinctive markings, if any:

3. State whether the art object has been exhibited in any exhibition, museum or gallery--
If so, give details:

4. Information concerning the consignor:
   (a) Name:
   (b) Address:
   (c) Nationality, under Executive Order No. 8389, as amended:
  
5. Information concerning the consignee:
   (a) Name:
   (b) Address:
   (c) Nationality, under Executive Order No. 8389, as amended: