4. This is an original work of multiple art. The work’s master was either created by the artist alone or by the artist and by others acting under the artist’s supervision and direction, the work’s master was created for the purpose of producing this work, the work was produced by or under the supervision and direction of the artist, and the work was approved by the artist after its completion. Yes _____ No _____ (If yes check one of the following:) The work’s master was created:
(a) By the artist alone. _____
(b) By the artist and others, acting under the artist’s supervision and direction. _____
5. Photomechanical reproduction was used to produce part or all of this work. Yes _____ No _____ (If yes, complete the following:) That part of the work which was reproduced photomechanically was first created in the medium of __________________.
6. (a) This work was produced in ______ (year) at _________________ (location). It was published and produced by _________________. It has the following image dimensions: ______________ and the following markings: _____________ (edition number or other identifier).
(b) (If a print, complete the following:) The work was printed on _________________(manufacturer) paper using the process known as ____________________(specify process, such as “lithography”,“serigraphy”, “etching”, “photomechanical reproduction”, etc.).
(c) (If a sculpture, complete the following:) The work is made of: _______________________________________________. .
7. The prior owners or custodians of this work were:
________________________________________________________________________________________________________________________________________________________.
8. This work is part of a limited edition. The total number of originals or copies that will be designated as part of any limited edition of this work has been established, in a manner that binds all further production, by a person who can control production of the limited edition. Yes _____ No _____ (If yes, complete the following:)
(a) The total number of works within this limited edition is ________. This edition consists of every original and copy of this work identified as being part of any limited edition, including any original or copy:
i. Produced on paper of a type different from the work.
ii. Exhibiting minor variations in size, color or image.
iii. Designated as a proof, artist’s copy, sample or part of a numbered or unnumbered series.
iv. Containing the image of the work.
v. Consisting of a portion of the image represented by the work.
(b) The following is a complete itemization of all works contained in this limited edition:
____________________________________________________________________________________________________________________________________________________________________________________________________________
(c) The master that produced this work was effaced or destroyed. Yes _____ No _____
Name of art dealer: _________________________________
Address: _________________________________________
Signed: __________________________________________
(Art dealer’s authorized representative)
Date: _____________________
Signed: __________________________________________
(Buyer)
Date: _____________________
Disclaimers:
(a) Buyer understands that he or she is entitled to inspect this work of art, but chooses to waive this right. This is a disclaimer—buyer is not required to sign here.
Signed: _________________________________________
(Buyer)
Date: _____________________
(b) Buyer understands he or she is entitled to the disclosures in this statement, but chooses to waive this right and buy this work on an “as is” basis. This is a disclaimer—buyer is not required to sign here.
Signed: __________________________________________
(Buyer)