(2) DECLARATION FORMS. Suppliers of investment art shall use the following declaration form: "INVESTMENT ART SUPPLIER'S DECLARATION
The state of Wisconsin requires that an art dealer retain a completed copy of this form for the sale of all works of multiple art the dealer has purchased on or after September 1, 1990 and will price at retail over $800 (not including the bona fide retail value of framing and mounting). These sales are regulated by ch. ATCP 117, Wis. Adm. Code, which is administered by the Department of Agriculture, Trade and Consumer Protection, 2811 Agriculture Drive, P.O. Box 8911, Madison, Wisconsin 53708-8911. Section 100.20, Wis. Stats., lists specific penalties and remedies for noncompliance, including penalties for misrepresentation made in this declaration.
All spaces on this form must be accurately filled in, except that the supplier may respond, where indicated, that a particular item is not being certified by the supplier or is not applicable. A "not certified" response indicates that the supplier cannot or will not certify the accuracy of the item.
Declaration of: ____________________________________ ___________________________________________________
(Art supplier's name and address)
1. Title of work of art: _______________________________2. Artist: _________________________________________3. I have sold or cosigned the above work of art to: ___________________________________________________ ___________________________________________________ (Art dealer's name and address)
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 _____ Not certified _____ (If yes, check one of the following:) The work's master was created: (a) By the artist alone. _____(b) By the artist and by others acting under the artist's supervision and direction. _____5. 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 _____6. Identifying numbers or markings: ________________7. I understand that this work of art will be offered for sale at a price in excess of $800.8. This work of art displays: (a) The authentic signature of the artist. Yes _____ No _____ Not certified_____(b) Authentic identifying numbers or other markings. Yes _____ No _____ Not certified _____ Signed: __________________________________________ (Supplier's authorized representative)
Date: ________________________"