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Insurance

THE MARYLAND INSTITUTE, COLLEGE OF ART
1300 MOUNT ROYAL AVENUE/BALTIMORE, MARYLAND 21217

The agreed or declared value of this property is hereby specifically stated by the Shipper not to exceed $ _______ 

Date  12-13-82

[[9 column table]]
GENE DAVIS: 4120 Harrison St. N.W.
| Consignee Name and Address | Commodity | Bags | Envs | Boxes | Other | Weight | PCC USE Charges | Ins. Value |
|---|---|---|---|---|---|---|---|---|

| "Sherwood Forest" (rolled) 1979 |   |   |   |   |   |   |   | $11,000. |

| "Plank Painting" (Red) 1974 |   |   |   |   |   |   |   | $5,000. |

| "Plank Painting" (Green) 1978 |   |   |   |   |   |   |   | $5,000. |

| "Yukoo Sonata" 1981 |   |   |   |   |   |   |   | $8,000. |

| "Black Diamond" 1963 |   |   |   |   |   |   |   | $20,000. |

| "Crosshatch" 1959 |   |   |   |   |   |   |   | $18,000. |

| "Captain Midnight" (rolled) 1979 |   |   |   |   |   |   |   | $8,000. |

| "Night Window" (rolled) 1980 |   |   |   |   |   |   |   | $8,000. |

SHIPPER SIGNATURE
DATE  TIME
COURIER SIGNATURE   [[?]]
DATE 12/13/82   TIME 1 PM
CONSIGNEE SIGNATURE
DATE   TIME AM PM

DAVID [[GERI??]]
[[?]]