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The services having been devoted exclusively to the business of the Consulate.

I certify that the statements in the above voucher are true.

FORM No. 167.

Clerk.

U. S. Consul.

(Paragraphs 183,539,574,575, and 587.)

UNITED STATES CONSULATE,

189-.

Statement of official services necessarily rendered, in accordance with the provisions of section 12 of the act of Congress approved June 26, 1884, for the vessel master, belonging to the port

of

No. of fee.

Nature of service.

Amount of fee as prescribed by the tariff.

U. S. Consul.

I certify that the above statement is correct and the services rendered were necessary.

Master of the Vessel.

N. B.-Consular officers are instructed to issue the above form in duplicate, and to send the duplicate to the Auditor for the State and other Departments with Form No. 168. The original is to be delivered to the master of the vessel, who must deliver it to the collector of the district in which the vessel first arrives on her return to the United States, and if such master fails to furnish such statement he is liable to a fine of not exceeding fifty dollars.

FORM NO. 168.

(Paragraphs 574,575,587,605.)

Detailed report of official services to American vessels and seamen necessarily rendered in accordance with the provisions of section 12 of the act of Congress approved June 26, 1884, by

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United States

189-.

Amount of
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of fees.

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before me, the undersigned, personally United States , and made oath in

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On this appeared due form of law that the above and foregoing report or statement of official services to American vessels and seamen is a true and correct statement of the official services performed by him for the American vessels above named for and during the period of time therein mentioned; that said services were actually and necessarily rendered by him at the instance and request of the masters of the respective vessels herein named; that no services are herein reported except such as were so actually and necessarily rendered in accordance with the provisions of section 12 of the act of Congress approved June 26, 1884, and that the amounts of the respective fees herein stated are in accordance with the tariff of consular fees prescribed by the order of the President of the United States.1

U. S.

Sworn to before me,

[To be transmitted quarterly to the Auditor for the State and other Departments by United States Consular officers compensated by fees.]

1 Leave six blank lines between text of oath and the signature thereto.

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Account of payments to masters and seamen of foreign vessels for rescuing American citizens, crews, etc.

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U. S. Consul.

Received from

[Voucher to accompany Form No. 170.]

consul of the United States at

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sum of —, in full payment for services in connection with the rescue of the crew of the American 189-.

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on the

day of

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Witness:

FORM NO. 171.

Statement of manufacturer to be annexed to invoice or to statement in the form of invoice of merchandise consigned for sale by him or on his account to a person in the United States.

I.

(Paragraph 674.)

of -, do solemnly and truly declare that I am the manufacturer of the merchandise mentioned and described in the1. and that the actual cost of production of such merchandise, including cost of materials and of fabrication, all general expenses of each and every outlay of whatever nature incident to such production, together with the expense of preparing and putting up such merchandise ready for shipment, is as follows, viz,

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Manufacturer.

do hereby certify that I believe the person who signed the foregoing statement is the person he represents himself to be, and that he this day signed the same in my presence.

Witness my hand and seal of office at

189-.

[L. S.]

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1 Certified invoice (or statement in the form of invoice) No.

- dated

FORM No. 172.

Statement of consignor, other than the manufacturer, to be annexed to invoice or to statement, in the form of invoice, of merchandise consigned for sale by him on his account to a person in the United States.

I,

(Paragraph 674.)

of, do solemnly and truly declare that I am the consignor of the merchandise mentioned and described in the1 and that said merchandise was actually purchased 2.

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on the

and that the merchanfor sale on my account, and

that I actually paid therefor the prices hereinafter detailed and set forth, viz,

Consignor.

I,

United States Consul at

do hereby certify that I believe the person who signed the foregoing statement is the person he represents himself to be, and that he this day signed the same in my presence.

Witness my hand and seal of office at

189-.

[L. S.]

this

day of

Consul of the United States.

FORMS NOS. 173, 174, and 175.

[Certificates of disinfection of hides are prescribed by the Secretary of the Treasury (see Paragraphs 381-384), and as they are subject to alteration by him from time to time, they are not included herein.]

1 Certified invoice (or statement in the form of invoice), No. 2 By me or on my account.

- dated

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