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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:
Please note that the language and terminology used in this collection reflects the context and culture of the time of its creation, and may include culturally sensitive information. As an historical document, its contents may be at odds with contemporary views and terminology. The information within this collection does not reflect the views of the Smithsonian Institution, but is available in its original form to facilitate research. For questions or comments regarding sensitive content, access, and use related to this collection, please contact transcribe@si.edu.