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[[form]] [[preprinted]] Customs Form 5269 TREASURY DEPARTMENT 99, C: A. M.; 8.40, 24.36, C. R. Form approved by Comptroller General, U.S., December 11, 1953 (Jan. 1954) NOTICE OF REFUND BUREAU OF CUSTOMS No. District No. ^[[10]], Port of ^[[New York, N.Y.,19 To ^[[Waldo L. Schmitt 111 Highland Lane Takoma Park, 12, Md]] There is a refund due you by the United States on account of [[boxed]] Excessive duties ^[[checkmark symbol]] | Excessive Internal Revenue Tax ^[[checkmark symbol]] [[/boxed]] [[boxed]] Drawback allowance | [[/boxed]] as per the particulars noted below. Check in payment is attached. KIND OF ENTRY|ENTRY No.|DATE OF ENTRY|CASE OR VOUCHER No.|AMOUNT CUSTOMS COLLECTIONS $--||AMOUNT INTERNAL REVENUE COLLECTIONS $--||REMARKS ^[[P Bagg]]|^[[428011]]|^[[5/2/56]]|-----|$----|^[[30]]|^[[$10]]|^[[50]]|----- ^[[Rec'd Sept. 12/56 Treasury Check #[[underlined]]29,245,932 for $10.80 [[/underlined]] dated Sept. 7/56]] Totals -----|$____|$____|_____ Total Refund___|$____|ROBERT W. DILL Collector of Customs ^[[D.H. GoldwaterFiscal Accountant]] By____________ U.S. GOVERNMENT PRINTING OFFICE 16--12399-4