BUREAU OF CUSTOMS 
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 
roved. > ' 
!au No. 
No. - YY'~ /< • 
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: 
Poet of_________ 
■* :♦ 
19.. 
Application is hereby made for inspection and certificate of registration of the following 
articles to be taken out of the United States, viz: 
(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.) 
1 Jtiam, eteI5?94i33a?rnted 
Owner_A 
f—crTapliHWl * 0btained from — 
To be sent or taken abroad for the purpose of__«_*_ 
oak inc; pxcl' um laii 
;ei 
(If for repairs or alterations, state nature thereof) 
To be shipped as 
'%£|A~U 
... on the_ 
i.) 
on or about __i 
ier or mail) 
m§ ’ 
I declare that the above statements are correct and true. 
(Sign here ) 
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) 
i - £ / • 
Capacity_ 
VV ■■ 5 
Address_ 
/ 
V 1 f 
Declared to before me on____., 19__ 
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 above-described articles, and make your return 
hereon unless otherwise directed. y 
£ € A$inq Deputy Collector. 
~ 
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Office of Appraiser, Port of 
^ — .-, 19-, 
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I certify that I have examined the above-described articles and find the articl^ in all particulars to be a/set forth above 
unless otherwise noted. 
,.-y J j£ ***** ** / -wj» 
7VJ^ : Piyy^r^wcx>'0 
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! t 19. 
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Syr 1 
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—--. 
Examiner. 
Acting Deputy Collector or Appraiser. 
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INSPECTOR'S RETU RN 
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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 
certificate for presentation to customs officers when articles are returned. If returned through another port, original must be transmitted to collector at port of e 
on request. No fee. 
as a 
entry 
U. S. GOVERNMENT PRINTING OFFICE 
10 — 9027-3 
