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[[pre-printed]] Form No. 253 FOREIGN SERVICE (Amended March 1944) FOREIGN SERVICE OF THE UNITED STATES OF AMERICA [[line]] DECLARATION IN CONNECTION WITH PAINTINGS, ETC., AND SCULPTURES To be entered under Paragraph 1807 of the Tariff Act of 1930 [[line]] ^[[Zurich, August 14th, 1957]] (Place and date) I,* ^[[F. Rusconi, Wasserwerkstr. 6, [[underline]]Zurich 6[[/underline]] ]]do hereby declare that I am the [[strikethrough]]painter or producer[[/strikethrough]] ^[[shipper]] of certain works of art, viz: ^[[ [[strikethrough]]No. 8492[[/strikethrough]] Marble Bas-Relief "Virgin & Child"with two Cherubs on top corner" [[underline]]packed in one twofold wooden case, marked JS & Co 3, total gross weight 89 kos.[[/underline]], total net weight 27,5 kos.]] covered by consular invoice No. ______, certified by the American Consul at ______ on the ______ day of ______, 19__; that the said paintings, pastels, drawings, and sketches are originals; [[underline]]that the said sculptures or statuary are originals[[/underline]] or the first or second replicas; and that the said etchings, engravings, or woodcuts were printed by hand from hand-etched or hand-engraved plates or blocks and [[underline]]are artists' proofs[[/underline]] ^[[attributed to Francesco di Simoni second half 15th. cent.]] ^[[ [[underline]]Port of Entry:[[/underline]] New York Intern. Airport [[underline]]Cosignee:[[/underline]] Mr. Germain SELIGMAN c/o Jaques Seligman & Co. Inc. 5 East 57th Street [[underline]]NEW YORK 22, N.Y.[[/underline]] ]] }SS: [[signed]]F. Rusconi[[/signed]] (Signature of [[strikethrough]]artist or shipper) [[/strikethrough]] ^[[shipper]] ^[[F. Rusconi, Wasserwerkstr. 6 Zurich 6]] [[line]] ^[[- CONSULAR LEGALIZATION NO LONGER REQUIRED -]] I, ______, Consul of the United States of America at ______, do hereby certify that the above declaration was subscribed and sworn to (or affirmed) before me by ______ on this ______ day of ______, 19 __, and that the statements therein contained are true to the best of my knowledge and belief. [[signature line]] Consul of the United States of America. No fee when issued with a consular invoice. [[line]] *If declared to by the foreign shipper the form should be changed to conform thereto, and a statement embodied therein showing why it was impracticable to obtain the declaration of the artist. U. S. GOVERNMENT PRINTING OFFICE 16-10608-2[[/pre-printed]]