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LOAN FORM   
THE MINNEAPOLIS INSTITUTE OF ARTS 
201 East 24th Street, 
Minnesota 55404
Telephone (612)339-7661, 
Cable: Minnari 

From: 
Byron Gallery       
1018 Madison Avenue
New York, N.Y. 10021

Return Address 
(If different from left.)

Purpose: Exhibition

Dates: October 17-November 24, 1968

To be insured By: [[X]] Borrower;  [ ] Lender. 
(if Lender, please supply waiver of subrogation against The Minneapolis Institute of Arts.)

Are photographs available: [ ] Yes; [X] No.

Shipment Via: [ ] REA [ ] Air Express [ ] Other______ 
To arrive no later than:
To be shipped on or about:

Credit line if different from above: Byron Gallery

Re: Sam Gilliam

The Loans Listed Hereunder are made Subject to the Conditions on the Reverse Side.

[6 columns]
| Lender's Number | Artist | Exact Title & Date | Medium & Support | Dimensions Height 1st | Insurance Value |
|---|---|---|---|---|---|
|---| Sam Gilliam | Shift Again | Acrylics | 104x45" | $ 1,700.00 |

Lender may retain the white copy. Please return all others to:
The Director, The Minneapolis Institute of Arts,
201 East 24th Street, Minneapolis, Minnesota 55104.
________________________
Lender's Signature
_____________
Title  
_____________
Date