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Form 7525-V (Rev. July 1962) (See Instructions on Reverse Side) U.S. DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS - BUREAU OF INTERNATIONAL COMMERCE SHIPPER'S EXPORT DECLARATION OF SHIPMENTS FROM 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 dock or other place of loading for the purpose of exporting by water or air; (b) must be presented to and authenticated by the Collector prior to exportation where the goods are exported by other means. Declarations Should Be Typewritten Or Prepared In Ink on the right corner Form approved. Budget Bureau No.41-R397.5. CONFIDENTIAL For use solely for official purpose authorized by the 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.) Do Not Use This Area | District | Port | Country (For customs use only) 1.From(U.S. Port of Export) | 2.Method of Transportation (check one); JFK Int'l | [box]Vessel [x]Air [box]Other(specify) 2a.Exporting Carrier (if vessel, give name of ship, flag and heir number. If air, give name of airline.) Swissair Airline 3.Exporter (Principal oe seller-licensee) Address (Number, street, place, state) Jacques Seligmann & Company 5 B, 57th St; NYC 4.Agent of Exporter (Forwarding agent) Address (Number, street, place, state) Bemo Shipping Co. Cargo Bldg#80 JFK Int'l 5.Ultimate Consignee Address (Number, street, place, state) Crowe & Co. Expediteur For Dr.F. & Dr, P. Nathan Zurioh, Switzerland 6.Intermediate Consignee Address (Place, country) Same Same 7.Foreign Port of Unloading (For vessel and air shipments only) Zurich 8.Place and Country of Ultimate Destination (not place of transshipment.) Zurich, Switzerland (9) | (10) | (11) | (12) | (13) | (14) | (15). Makes |Number and kind |Shipping |Specify |Schedule |Net |value At U.S. and |of Packages,Description|(Gross) |"D" or |B |Quantity |Port of Nos. |Description of |Weight in |"F"^b |Commodity|in |Export |Commodities, Export |Pounds | |No. |Schedule |(selling |License Number, |(required | | |B Unite |price or cost |Expiration Date (Or |for vessel| | |(State unit)|if not sold, |General License Symbol)|and air | | | |including in- |(Describe commodities |shipments | | | |land freight, |in sufficient detail to|only | | | |insurance and |permit verification of | | | | |other charges |the Schedule B | | | | |to U.S. port |commodity numbers | | | | |of export) |assigned. Do not use | | | | |(Nearest |general terms. Insert | | | | |whole dollar; |required license | | | | |omit cents |information on line | | | | |figures) |below | | | | | Adr |One pol: oil Paintings | I2I# | F |896.0000 | |$34,000.00 JS-I |Title "Portrait of an | | | | |Est. Value |Elderly Man" | | | | | G.Dest These commodities licensed by U.S. for ultimate destination Switzerland Diversion contrary to U.S. law prohibited. 16.Waybill or Manifest No. (of Exporting Carrier) Swissair AWB: 085-417-2785I 17.Date of Exportation (Not required for shipment by vessel) 18.The Undersigned Hereby Authorizes___________________________________________________ To ACT as Forwarding Agent For Export Control And Customs Purposes. (Name and address-Number, street, place, State) Expoter________________ BY (DULY AUTHORIZED OFFICER OR EMPLOYEE) Aty: Bemo Shipping Co: 19.I CERTIFY THAT ALL STATEMENT MADE AND ALL INFORMATION CONTAINED 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 Walt Bolzendahl Aty: {signature:Walt Bolzendahl} For ________________________ (Duly authorized officer or employee of exporter or named (Name of corporation or forwarding agent) firm, and capacity of signer:e.g., secretary, export manager, etc.) Address________________________________________________________________________________ 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 listed in column (18) 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(reports( with an "F" an exports of domestic merchandise produced in the United States or changed in condition in the United State with a "D"(See instruction on revers side.) CARRIERS FORWARDERS AND EXPORTERS ARE REMAINED THAT IF A DESTINATION CONTROL STATEMENT IS REQUIRED ON A SHIPPER'S EXPORT DECLARATION COVERING A GIVEN SHIPMENT, SUCH STATEMENT MUST ALSO APPEAR ON ALL COPIES OF THE HILL OF LANDING AND COMMERCIAL INVOICE. (See Comprehensive Export Schedule.) Bottom left Do Not Use This Area