Gambar halaman
PDF
ePub

I,

Certificate to the declaration of an American artist.

[ocr errors]

Consul of the United States at, do hereby cer

tify that the within declaration was subscribed and sworn [or affirmed]

to before me by

an artist residing at

[ocr errors][merged small]

the best of my knowledge and belief. [L. S.]

U. S. Consul.

I,

FORM NO. 156.

Certificate to accompany natural mineral waters.

of

owner [or manager] of

[ocr errors]

(Paragraph 708.)

do hereby declare under oath that I am the [designate and locate the spring or springs], that the mineral water specified in the annexed invoice is the natural product of said spring [or springs], and that the same has been in no way artificially prepared.

[blocks in formation]

Manifest of fish [or oil or other product of the fishery] taken by the [naming the fishing vessel] of the port of in the United States, duly documented under the laws of the United States, landed at the port of and destined for transshipment by the [naming vessel to which transferred and the route, if destined to cross either isthmus route], to the port of -, in the United States; said fish [or oil or

other product] having been taken by the crew or company of said vessel, while at sea, since the

Marks.

day of

189-.

Packages.

Port of entry in United
States.

Consignees.

Value.

I, that said

master of the said [fishing vessel], do hereby certify above specified, was taken by the crew or company of

said vessel and landed at the port of

-, to be shipped to the port of

in the United States, by the [name of importing vessel] of I further certify that the above is a true and faithful manifest of said according to the best of my knowledge and belief.

[merged small][merged small][merged small][merged small][ocr errors][merged small]

I,

FORM NO. 158.

Certificate of United States Consul to manifest of fishing vessel.

[ocr errors]

(Paragraph 717.)

CONSULATE OF THE UNITED STATES,

→ 189

United States Consul [or commercial agent] for the

port of -, do hereby certify that the above certificate was subscribed and sworn [or affirmed] to before me by the ——, of

—, master of

—, and that I fully believe the statements therein to be true in every particular.

I also certify that I have examined the papers of said vessel and find her to be an American vessel, owned by

master, as shown by her register license], numbered issued at the port of

[SEAL.]

commanded by [or enrollment or

189-.

U. S. Consul.

FORM NO. 159.

Quarterly transcript of the record of notarial and unofficial services, at , for the quarter ending the

the Consulate at

day of

[blocks in formation]

I solemnly swear that the foregoing record of notarial and unofficial services is a full and correct transcript of the record of this Consulate, and that the same contains a true and accurate statement of all the fees received at this Consulate for such services during the period named.

Subscribed and sworn to before me this

day of

U. S. Consul. 189-.

FORM NO. 160.

Form of average bond.

(Paragraph 188.)

Average bond of steamer (or schooner or ship, as the case may be.)

Whereas the steamer

whereof

is master, having

on board a cargo of assorted merchandise, left the port of, in the State of -, on or about the day of, one thousand eight hundred and ninety, bound for the port of of, and intermediate ports.

-, in the

And whereas, while in prosecution of said voyage, the said steamer

did meet with a disaster, by which means certain losses and

expenses have been incurred, and other expenses may hereafter be incurred in consequence thereof, which, according to the usage on the western inland waters, constitutes a general average to be apportioned on said steamboat, her earnings as freight, and her cargo.

Now we, the subscribers, being owners, shippers, or consignees, or agents or attorneys of owners, shippers, or consignees of said steamboat —————, cargo, or freight, do hereby, for ourselves, our executors and administrators, severally and respectively, but not jointly, nor one for the other, covenant and agree to and with each other, and also separately to and with the master or other legal representatives of said steamboat and cargo, that the loss or damage aforesaid as shall be made to appear to be due from us, the subscribers, or from those whom we represent, shall be paid by us respectively on demand, according to our shares in the said steamboat, cargo, or earnings as freight, and that such losses and expenses be stated and apportioned, in accordance with the established usages and laws upon the waters of , by

[merged small][merged small][ocr errors][merged small]

For the true performance of which we do severally bind ourselves. our principals, heirs, executors, administrators, and assigns, to each other, and separately to the said steamer -, master, or representative of the said steamboat and cargo, as the general representative of all parties at interest.

In witness whereof we have hereunto set our hands and seals on this in the year of our Lord one thousand eight hundred

day of

and ninety

[ocr errors]
[ocr errors]

NOTE.-Parties signing the bond will produce the invoice of goods and insert amount of the same on the bond.

Name of consignee. Number of articles. Invoice value. By whom the average bond is signed.

1 Clerk of the boat or vessel will fill this out before leaving.

2 To be filled out by signer of the bond.

FORM NO. 161.

Table for the reduction of sterling money of Great Britain to United States gold coin, under act approved March 3, 1873, fixing the value of the pound sterling at $4.8665.

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

17824 C R-51

« SebelumnyaLanjutkan »