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6. Names of countries in which article has been located since March 12, 1938:

7. If the art object has been imported from any country in the Western Hemisphere, except one which constitutes a part of the United Kingdom, British Dominions, or British Colonies, state whether it has been continuously in the Western Hemisphere since March 12, 1983.

8. Name, address, and nationality under Executive Order No. 8389, as amended, of every person having an interest in the art object, direct or indirect, since March 12, 1938, including every person now having any interest. Indicate period of time during which each person had an interest.

9. Manner in which present owner acquired art object, and date and place of such acquisition. If by purchase, indicate price and currency in which payment was made.

10. State purpose of importation or exportation.

11. Have any similar importations or exportations been made by you since September, 1939?

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Signature of person signing report

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Date