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[[top left]] Form 7525-V ([[?]] July 1962) (See Instructions on Reverse Side) U.S. Department of Commerce Bureau of the Census- Bureau of International Programs Shipper's Export Declaration of Shipments Form the United States Export Shipments Are Subject To U.S. Customs Inspection READ CAREFULLY THE INSTRUCTIONS ON BACK TO AVOID DELAY AT SHIPPING POINT For shipments to foreign countries, the export declaration (a) must be presented to and authenticated by the Collector of Customs before the goods are placed on pier or deck or other place of loading for the purpose of exporting by water or air; (b) must be presented to and authenticated by the Collect prior to exportation where the goods are exported by other means. Declaration Should be Typewritten Or Prepared in Ink | [top right] Form Approved. Budget Bureau No. 41-R397.5. | CONFIDENTIAL For use solely for official Secretary of Commerce. Use for unauthorized purposes is not permitted (Title 15, Sec. 30.5 (b) C.F.R.; 50 U.S.C. App., 2026c.) | Customs Authentication (For Customs use only.) | FILE NO. (For Customs use only) | [from the left] Do Not Use This Area | District | Port | Country (For customs use only) | 1. From (U.S. Port of Export) New York | 2. Method of Transportation (check one): Vessel (incl. ferry) Air Other (Specify) Air-Express | 2a. Exporting Carrier (If vessel, give name of ship, flag, and pier number. If air, give name of airline.) REA-Agency | 3. Exporter (Principal or seller-licensee) Jacques Seligmann & Co., Inc. Address (Number, street, place, state) 5 East 57th Street, New York 22, N.Y. | 4. Agent of Exporter (Forwarding agent) Address (Number, street, place, state) | 5. Ultimate Consignee Mr. Victor Lynch-Staunton Address (Place Country) Clydegh Nashville (Ontario) Canada | 6. Intermediate Consignee Thompson, Ahorn & Co., Customs Brokers Address (Place, country) 40 Yonge Street, Toronto, Canada | 7. Foreign Port of Unloading (For vessel and air shipments only) Toronto, Canada | 8. Place and Country of Ultimate Destination (Not place of transshipment Nashville, Ont.-- Canada [table] |[Column 1] (9) Marks and Nos. | 1 | [Column 2] (10) umber and Kind of Packages, Descriptions of Commodities, Export License Number, Expiration Date (or General License Symbol) (Describe commodities in sufficient detail to permit verification of the Schedule B commodity numbers assigned. Do not use general terms. Insert required license information on line below description of each item) | Case addressed: shipped on approval | "Man in Oriental Costume" | painting(framed) by F. GUARDI | | "Portait d'Homme en Pied" | framed pencil drawing by | Eugene Amaury-Duval [Column 3] (11) Shipping (Gross) Weight in Pounds (required for vessel and air shipments only) | [Column 4] (12) Specify "D" or "F" | | | F | | | | F | [Column 5] (13) Schedule B Commodity No. | | | 96100 | | | | 96100 | [Column 6] (14) Net Quantity in Schedule B Units (State unit) | [Column 7] (15) Value At U.S. Port of Export (Selling price or cost if not sold, including inland freight, insurance and ther charges to U.S. port of export) (Nearest whole dollar; omit cents figures) | | | $ 9,000.-- | | | | $1,500.-- [bottom of page] 16. Waybill or Manifest No. (of Exporting Carrier) | 17. Date of Exportation (Not Required for shipments by vessel) Nov. 28, 1964 | 18. The Undersigned Hereby Authorizes _______ to Act as Forwarding Agent for Export Control and Customs Purposes. (Name and address-Number, street, place, State) Exporter Jacques Seligmann & Co., INC. by (Duly Authorized Officer or Employee) ______ | 19. I Certify That All Statements Made and All Information Contained in This Export Declaration Are True and Correct. I am Aware of the Penalties Provided for False Representation. (See Paragraphs I (c), (e), on reverse side.) Signature _____ For Jacques Seligmann & Co., INC. Manager (Duly authorized officer or employee of exporter or named forwarding agent) (Name of corporation or firm, and capacity of signer, e.g., secretary, export manager, etc.) | Declaration should be made by duly authorized officer or employee of exporter or of forwarding agent named by exporter. If shipping weight is not available for each Schedule B item listen in column (13) included in one or more packages, insert the approximate gross weight for each Schedule B item. The total of these estimated weights should equal the actual weight of the entire package or packages. Designate foreign merchandise (reexports) with an "F" and exports of domestic merchandise produced in the United States or changed in condition in the United States with a "D." (See instructions on reverse side.) CARRIERS, FORWARDERS AND EXPORTERS ARE REMINDED THAT IF A DESTINATION CONTROL STATEMENT IS REQUIRED ON A SHIPPER'S EXPORT DECLATAION COVERING A GIVEN SHIPMENT, SUCH STATEMENT MUST ALSO APPEAR ON ALL COPIES OF THE CILL OF LAFING AND COMMERCIAL INVOICE. (See Comprehensive Export Schedule.) | Do Not Use This Area
