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DECLARATION FOR THE FREE ENTRY OF WORKS OF ART, THE PRODUCTION OF AMERICAN ARTISTS RESIDING ABROAD, AS PROVIDED FOR BY PARAGRAPH 1707, ACT OF SEPTEMBER 21, 1922. 
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TREASURY DEPARTMENT 
Customs Form 3319 
ART 429, C. R. 1923
C. D. May 23-25 

United States Customs Service, 
DISTRICT NO. ________

Port of _______________, _____________, 192 

I, _______________, do hereby certify that I am a citizen of the United States of America, and by profession __________ [artist or sculptor]; that my place of permanent residence is _____________; that I departed from the United States of America on or about the ________ day of ___________, A. D. 19___, to take up temporarily my residence at __________________; that I have not given up, and it is not my intention to give up, my residence in the United States, and that it is my purpose to settle ultimately in the United States. I further certify that the _____________ [painting or statue] hereafter described is my own production, having been produced at _____________________ during my temporary residence abroad, as above stated: 
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[[three column table]] 
TITLE OF WORK | VALUE- Of Work. | VALUE- Of Frame. 
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(Signature of artist or sculptor) ____________________

Personally appeared before me, at the place and time above stated, the said _______________________, known to me to be the identical person named, and subscribed and made declaration to the foregoing. 
________________________Collector. 

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