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[[preprinted]] 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.: [[blank line]] (b) Port of entry: [[blank line]] (c) Date of importation: [[blank line]] (d) Country of export: [[blank line]] (e) Date of export shipment: [[blank line]] 2. Description of art object - (a) Category (painting, sculpture, ceramics, etc.): [[blank line]] (b) Title of work, if any: [[blank line]] (c) Material composition: [[blank line]] (d) Dimensions (without frame, mat, pedestal, etc.): [[blank line]] (e) Name of foreign country in which art object was created: [[blank line]] (f) Name of artist or craftsman: [[blank line]] (g) Approximate date of work: [[blank line]] (h) Distinctive markings, if any: [[blank line]] 3. State whether the art object has been exhibited in any exhibition, museum, or gallery....If so, give details: [[blank line]] 4. Information concerning the consignor: (a) Name: [[blank line]] (b) Address: [[blank line]] (c) Nationality, under Executive Order No. 8389, as amended: [[blank line]] 5. Information concerning the consignee: (a) Name: [[blank line]] (b) Address: [[blank line]] (c) Nationality, under Executive Order No. 8389, as amended: [[blank line]] [[/preprinted]]