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The object(s) described below has (have) been received/released by:

PVI GALLERY
173 East 73rd Street
New York, New York

December 30, 1964

TO/FROM:
Name  Stable Gallery
Telephone
Address 33 East 74

For (purpose):

Artist              Description
R. Indiana          34 x 34 oil -

Signed: [[?]]
Date: Dec 30/64