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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