Customs Form 4455 
TREASURY DEPARTMENT 
10.8, 10.68, C. M. 1943; 
10.8, 10.28, 10.42, 10.68, C. R. 1943 
January 1945 
BUREAU OF CUSTOMS 
No. jdlr . 
APPLICATION FOR AND CERTIFICATE OF REGISTRATION OF ARTICLES TO BE EXPORTED FOR REPAIRS OR ALTERATIONS, 
PERSONAL USE, TOURING, ETC., ALSO THEATRICAL EFFECTS, MOVING-PICTURE FILMS, AND TRAVELERS’ SAMPLES 
/ • 
To the Collector of Customs: 
Port of JA.._A / . LlA +1 . .19. 
Application is hereby made for inspection and certificate of registration of Jbhe following 
articles to be taken out of the United States, viz: A f 4 *) i 3 / 6 K 
m #9 *g 
(i'-vu '1 r ' ¥‘,J L^Pl-44 (/r.cc. *t !}& i i yi 
(This space for use of examiner. If expor¬ 
tation is for repairs or alterations, notation 
, should be made by examiner on both copies 
as to whether the work to be done is believed 
to be within the purview of Sec. 10.8, C. R. 
1943.) 
(Describe fully, giving quantity, material, color, type, make, identification numbers, etc. One unmounted 
. U„cdl/'.c u C-i i\ t.'i A c • ?it ■- U .... 
photograph may be required) „ / / [ 
~LdLjx _ idlLSUA^l _..._ 
$*' /TT«^ J r _ _ _ • J * 1 m , • « . « . . .4 
Owner . Lj 4 
IDO U d 
/U% tj ^4 14 %. 
Obtained from _ Place 
(Dealer) 
To be sent or taken abroad for the purpose of ..._irntr._ 
(Repairs, alterations, personal use, touring, etc.) 
(Address) 
I 
(If for repairs or alterations, state nature thereof) 
To be shipped as on the i’fZfAt yf._ on or about _^-*.-jZ.ZZA_,Z_, 19. 
(Freight, A>aigagefetc.) ‘- 
.**■ 
o 
(Carrier or mail) 
I declare that the above statements are correct and true. 
(Sign here) 
i 
Place ..... Time...... 
(Articles must be delivered to appraiser for inspection. If such delivery is impracti¬ 
cable for any reason, state on line above the place and time when inspection is desired) 
L 2! £ f " '4 
Capacity_Z_Z----/_ 
2L..7/. 
Address 
c .. t -. i 
t 
>•4 ■{- % t 
)L 
C« 4 &.. W -A- 
Declared to before me on_ IQ&J? 
To the Appraiser: You will examine the above-described articles and make your return hereon. 
To the Inspector: You will supervise the packing, transfer, and lading of the jp^ove-described articles, and make your return 
hereon unless otherwise directed. 
Office of Appraiser, Port of - 
, Acting Deputy Collector. 
t 
I certify that I have examined the above-described articles and find the articles in all particulars to be as set forth above 
unless otherwise noted. ****** 
f * mmJfc 10 i ** i J ^ ~ ~ L */ r , ] „*«'*** . _ /? 
1-4_, 19JlA 
n i 
m * p ■ si i vv 
---- 4 --—-■- 
., . __ r ... 
V* —•"y’ --J A ^ — —--r—•——— — — — £*• — — — - — — -— — —— ——---.--a— — — -—— ---— - 
Examiner. Appraiser. 
INSPECTOR'S RETURN 
To the Collector: 
I certify that I have supervised the packing and transfer of the above-described goods and found them as described above, 
except as noted, and supervised the lading thereof on board the_____on 
(Carrier or P.O. Register No.) 
Station ,..., 19 
., 19 . 
., Inspector. 
This form to be filed in duplicate, one copy to be retained as customs record, and duplicate, when signed by appraiser or collector, to be delivered to applicant as a 
certificate for presentation to customs officers when articles are returned. If returned through another port, original must be transmitted to collector at port of entry 
on request. No fee. 
U.S. GOVERNMENT PRINTING OFFICE 
16-9627-1 
