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[[Buffalo Fine Arts Academy form. All text is preprinted except for inserted text]]

THE BUFFALO FINE ARTS GALLERY BUFFALO, N. Y.
CASE NO. IN: ^[[C4]]
DATE REC'D: ^[[1-6-23]]
NAME OF ARTIST: ^[[Van der Meulen]]
TITLE OF WORK: ^[[Lord Cobham's deeds: The operations of the Siege of Lille, Battle of Wynendael Woods]]
KIND OF WORK: ^[[Tapestry]]
MARKS: [[blank]]
RECEIVED FROM: ^[[Jacques Seligmann and Co.]]
[[ADDRESS]]: ^[[705 Fifth Ave., New York City.]]
EXPRESS: ^[[Am.]]
COLLECT OR PREPAID: [[COLLECT struck through]]

CONDITION INCOMING
FRAME: [[blank]]
CANVAS: [[blank]]
GLASS: [[blank]]
SIGNATURE: ^[[A Leeder]]

INCOMING NOTICE
Receipt of the work described above is hereby acknowledged.
CORNELIA B. SAGE QUINTON, Director
By: ^[[B.H.]]