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OUT

ART LENDING SERVICE
of the MUSEUM OF MODERN ART
21 West 53rd Street
New York 19, N. Y.

DELIVERED THE FOLLOWING ITEMS
ON: 4/10/63 
TO: Print Room MOMA

(3) GALLERY COPY

Date:
Order No:

The undersigned acknowledges receipt of the following items heretofore delivered and/or cosigned to the Art Lending Service of the Museum of Modern Art:

[[5 Columned Table]]
|ALS No. | ARTIST | TITLE | MEDIUM | VALUE|
| 623-315 | Robert INDIANA | The AMERICAN HAY CO. | Conte crayon | $175.

The undersigned reserves the right to Inspect the returned articles and to make claim for damages in writing within ten days of the date of the receipt by the undersigned of the aforementioned articles if they are found not to have been returned in satisfactory condition, it being understood and agreed that if such a claim is not made within such period the Art Lending Service of the Museum of Modern Art is release from any and all responsibility with respect to such articles.

Date Received______(Signed)_______for_______Gallery

[[right margin]]THIS copy is for your files; please sign and return the white copy.)[[/right margin]]