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Form No. A.D. 83 1/2-M.A. 8 1/2 Size-Effective 1960
(M-A)-Form of Invoice Approved by Canadian Customs (1959) for Goods Sold by Exporter Prior to Importation, for Entry at Most Favored Nation Tariff Rates

(Place and Date) New York, November 1st 1961 Invoice No. ____

Invoice of General nature or class of merchandise Atique Work of Art

by Mr. Victor Lynch-Staunton of Nashville Ont. c/o Thompson Ahern & Co. Toronto-Canada

from Jacques Seligmann & Co., Inc. of New York, N.Y., U.S.A.

to be shipped from New York per Air Express (Railway Express Agency)

Customer's Order's No._______ Our Order No.____ Terms______ 

|Country of Origin|Marks and Numbers on Packages|QUANTITIES AND DESCRIPTION OF GOODS|Fair Market Value at time of shipment in currency of country of export(See clauses 5 to 8 of certificate of value hereon)|Selling Price to the Purchaser in Canada (Specify currency of settlement @ Amount|
|---|---|---|---|---|
|France|addressed|One(1)Box-One(1)inner box Marble High-Relief- Fragment French 2nd half XIVth Century Representing "PENTECOST" Out of Bond Price US Duty Free| Us.$ 3,500.-|US$3,500.|

NOTE:
The following facts must be shown:
Amount of:
Freight, if any, prepaid and charged____
Freight, if any, prepaid and not charged $9.25
Freight, if any, allowed to be deducted
by importer on settlement______
*If any freight is prepaid by the exporter and not charged, or is allowed to be deducted by the importer on settlement, a statement must be Ade on this invoice indicating whether or not the practice is consistent with the exporter's domestic market freight policy.
(Over)