Gambar halaman
PDF
ePub

FORM NO. 82.

Certificate of shipment of seamen or marines attached to crew-list aud

shipping-articles.

(Paragraph 188.)

I,

CONSULATE OF THE UNITED STATES OF AMERICA AT

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

Consul of the United States of America for the dependencies thereof, do hereby certify that the seamen or mariners hereinafter named have been duly shipped at this port, before me, upa the terms and conditions set opposite their names, respectively, viz:

[blocks in formation]

tion the high rate of wages for seamen, ordinary seamen, cooks, and

(Paragraph 188.)

master of the

of

—, taking into considera

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

inafter named, belonging to the said vessel, as increased wages, begin

ing from the

day of

and continuing until the termination the voyage, agreeably to the contract of shipping-articles signed by em, a certified copy of which is hereto annexed, dated

189-.

[ocr errors]

Master.

Attested: [L. S.]

U. S. Consul.

FORM NO. 84.

orm to be used when shipwrecked seamen are picked up at sea and

conveyed home, or to any other port.

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

mnly and sincerely declare that I received on board the said vessel at

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

3

[ocr errors]

of

of the bur

-].

I further declare that I landed them on the day or days, place or laces, set forth in the statement underneath, and subsisted them the umber of days against each person expressed, making in the whole? -days; and that during the whole of such time I had my full comlement of men and boys, viz: men and boys, exclusive of the inder-mentioned seamen, for whom I now claim subsistence; and in ›roof of the justice of the claim I am willing (if required) to produce ny log-book and the declaration of the mate and carpenter; and I make his solemn declaration, conscientiously believing the same to be true. I further declare that 4 were saved from the wrecked vessel.

1 The words between [] must be repeated for every wrecked vessel, when moro han one, to which the seamen belonged.

2 The number here is to be inserted in words at length.

* If the full complement not on board, state how many were deficient.

Here insert the words "not any provisions," or (as the case may be), "the provi dons specifically stated, and the value thereof."

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

Receipt by Consul for effects of a deceased seaman.

(Paragraph 255.)

When and where
landed, or how
disposed of.

Port.

Date.

Master.

U. S. Consul

[blocks in formation]

I certify that the above-named master has paid me the above-named sum, and has delivered to me the above-named effects, as the money, goods, and effects of the above-named deceased, which he left on board

Number of days

on board,

this death, I having considered it expedient that the said money, goods, nd effects should be delivered to me.

[blocks in formation]

o the district judge of the United States for the district of ·
On the
Inited States vessel

day of

189-.

[ocr errors]

:

I received from master of the goods and effects, the property of

a seaman on said vessel, deceased, and gave therefor the inclosed eceipt. The deceased had also within the limits of my Consulate other fects not on board said vessel, as shown in the inclosed inventory. I used the effects to be sold at auction, and now have the honor, in ɔmpliance with the provisions of section 4541 of the Revised Statutes, › inclose a statement of account, together with a draft on for

- days' sight for

the balance to my debit; and to say

at I hold myself ready to render any further account which you may quire.

Witness my hand and Consular seal at

. D. 189-.

[SEAL.]

the

day of

U. S. Consul.

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

were united in marriage before me, and in my presence, by who is authorized by the laws of

mony.

to perform such a c

In witness whereof I have hereunto subscribed my name and affiell the seal of the Consulate at ——, this — day of and of the Independence of the United States the

-, A. D. 18.

U. S Consul.

I,

FORM NO. 88.

Form for authentication of signatures.

(Paragraphs 188 and 446.)

UNITED STATES CONSULATE,

Consul of the United States at

189-. do hereby certify that the signature of at the foot of the paper hereto annexed, is his true and genuine signature, made and acknowledged in my presence, and that the said

is personally known to me.

In witness whereof I have hereunto set my hand and affixed the seal of the Consulate at, this day and year next above written, and of the Independence of the United States the

FORM No. 89.

U. S. Consul.

I,

Certificate that an officer is qualified to administer an oath.

[ocr errors]

(Paragraphs 188 and 446.)

Consul of the United States of America at

- do hereby certify and make known to whom these presents shall come that before whom the annexed affidavit [oath, or declaration, as the case may be] of hath been made, is a Commissioner in the High Court of Chancery, in England, duly authorized to administer oaths and affirmations, and take declarations in lieu of oaths, and that I believe the deponent is worthy of credit and qualified to verify the annexed affidavit. In testimony whereof I have hereunto set my hand and seal of office, 189-.

at

aforesaid, this

day of

U. S. Consul.

« SebelumnyaLanjutkan »