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THE MUSEUM OF FINE ARTS OF HOUSTON Main Street and Montrose Boulevard Houston 5, Texas We would greatly appreciate your filling in this form. EXHIBITIONS and DATES: HOUSE OF ART Oct. 17 - Nov. 28, 1954 LENDER: Jacques Seligmann & Co., Inc. ADDRESS: 5 East 57th Street, New York, N.Y. ARTIST: French TITLE: "Head of a Saint" MEDIUM: Limestone DIMENSIONS: Height 4" (head) SIGNED, DATED & LOCATION: DATE OF EXECUTION, IF KNOWN: end of XIV - early XV century (the bronze crown is of a later period). FORMER COLLECTIONS: OTHER EXHIBITIONS: IF PUBLISHED OR REPRODUCED: Will you permit use of your name as lender in the catalogue? Yes If not, what acknowledgement is desired? INSURANCE: Do you prefer to carry your own wall to wall insurance Yes X No __ If not, for what value shall we insure the work? REMARKS OR SPECIAL RESTRICTIONS: VALUATION: $1,200 If for sale, for what price? $1,200 SHIPMENT DATES: ADDRESS TO WHICH OBJECT IS TO BE RETURNED: Above OTHER INFORMATION: SIGNATURE OF LENDER: