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[[preprinted]] Customs Form 6063 TREASURY DEPARTMENT May 1953 Form approved. Budget Bureau No. 48-R263.2. BAGGAGE DECLARATION AND ENTRY ☛(BEFORE FILLING OUT THIS DECLARATION, READ CAREFULLY INSTRUCTIONS ON BACK OF THIS SHEET) No. [[strikethrough]] 428003 [[/strikethrough]] ^[[428011]] Port ^[[New York]] Arriving by ^[[Alcoa Runner]] I, (Print your name)^[[Waldo L. Schmitt]] declare that my home address is (Street and number) ^[[111 Highland Lane]] (City, Zone, and State) ^[[Takoma Park 12 Md.]] that I am a resident of the country of ^[[U.S.]] since ^[[June 25, 1887]]; that I am a citizen of ^[[U. S.]]; that I last left the United States from ^[[New York]] on ^[[March 2]], 19^[[56]] and that I am accompanied by the following [[strikethrough]] members of my family and household: (Names and relationship by blood, marriage, or adoption) [[/strikethough]] Total pieces of baggage: ^[[7]] Date of last previous arrival in the United States ^[[June 27]], 19^[[56]] [[table]] ----|----|---- (Read carefully the Instructions on other side of this form and the declaration below DESCRIPTION OF ARTICLES (Gegenstände) (Articles) (Articoli) (Artículos)(ARTICLES OBTAINED FOR USE OF AND ACCOMPANYING PASSENGER)| PRICE PAID, OR FAIR VALUE IF GIFTS, ETC. | FOR CUSTOMS OFFICER"S NOTATIONS ONLY (Nur für Bemerkungen der Zollbeamten)(Pour les emplyés a la douane seulement) (Da ríempisirsl solament dagli uffíciali de dogana) (Sólo para las anotaciones de los empleados de aduanas) ^[[8 bottles liquor]] |^[[20.00]] | ^[[ [[circled]] 3 liquor 7 wine 9 rum [[/circled]] 19]] ^[[7 " [[ditto for bottles]] wine]] | ^[[25.00]] |---- ^[[6 " [[ditto for bottles]] perfume]] | ^[[23.95]]|---- ^[[10 cocktail glasses]] | ^10.00 |---- ^[[3 dolls & handbasket & hat]] | 10.50 |---- ^[[1 shawl]] | ^[[3.50]] |---- [[strikethrough]] ^[[1 toy hat]][[/strikethrough]]| ^[[.50]]|---- ^[[ 1 silver pin.|2.25]]|---- ^[[[[heddaces?]] & belt]]|^[[6.00]]|---- ----|----|^[[19]] ----|----|^[[5 20.00]] ----|----| ^[[ 3.40]] ----|----| ^[[ 25.00]] ----|----| ^[[tally line]] ----|----| ^[[ 48.40]] ARTICLES [[strikethrough]]INTENDED FOR SALE AND ARTICLES NOT OWNED BY YOU, ACQUIRED OR [[/strikethrough]] CARRIED FOR OTHER PERSONS|^[[101.10]]|---- [[line]] ^[[ 5 bottles liquor (cost 68¢ ea| 3.40]]|---- ^[[(declared as unaccompanied baggage by Albert C. Smith]]|----|Cashier's Stamp|TOTAL DUTY OR FINE $[[blank]] NUMBER OF CONTINUOUS SHEETS ATTACHED|[[blank]] [[vertical in left margin]] If more space is required, use continuation sheet, Customs Form 6063—Cont. [[/vertical in left margin]] [[/table]] [[double line]] DECLARATION OF NONRESIDENT OF THE UNITED STATES I further and declare that all articles contained in my baggage or on my person that are for sale, business purposes, gifts, or the use of others, or those articles which are not strictly personal effects, together with the purchase price or fair value if not obtained by purchase, are listed above. ☛___________ (signature) _____________(ADDRESS IN THE UNITED STATES) _____________ [[double line]] Declared to be for me____,19__, and baggage examined and found it correct unless otherwise noted. Number of packages examined____ and number of stamps used______ _______, Inspector. Baggage stamps Nos.____________ [[declaration below right column]] DECLARATION OF RETURNING UNITED STATES RESIDENT I further declare that all articles contained in my baggage or on my person, or in baggage or in the persons named above, however obtained abroad, together with the purchase price, or fair value for articles not obtained by purchase, are listed above; that such articles unless otherwise noted, were acquired incidental to the trip; that they are for the personal use of the persons named above, and that except as specifically stated hereunder, neither I nor any person for whom this declaration is made has claimed to the $200 exemption during the 30-day period, or the $300 exemption during the 6-month period, preceding the date of this declaration. _________________ _________________ ☛^[[Waldo L. Schmitt]] (Signature) [[double line]] VALUE AND DUTY AS NOTED ABOVE ________Appraiser's Examiner. ________Acting Deputy Coll'r. 16 [[?]] [[section of bottom torn off, not readable]]
