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FORM NO. 99.

[Weekly Sanitary Report is furnished by the Treasury Department. See paragraph 380.]

FORM NO. 100.

Requisition for stationery supplies for consulates.

(Paragraph 429.)

189-.

To

Assistant Secretary of State, Washington, D. C.

SIR: I have the honor to request that the articles of stationery named below be furnished for use at this office.

I have the honor to be, sir, your obedient servant,

Number

of item on Quantities.* schedule.

Articles

(Put but one item on a line.)

Quantities recommended by Chief of Consular Bureau.

* Quantities desired should be expressed in figures, and if less than an original package is required the quantity should be stated in proper terms, i. e., rm., M., gr., doz., lb., etc.

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before me, the undersigned, personally apUnited States Consul at

—, and made oath that

the above and foregoing account or report of fees is a full and perfect transcript of the register which he is by law required to keep; that the same is true and correct, and contains a full and accurate statement of all fees received by him as such Consular Officer, or for his use, for his official services, to the best of his knowledge, during the period of time therein mentioned.

Sworn to before me.

[NOTE. This form is to be transmitted to the Auditor for the State and other De partments at the end of each quarter.]

U. S. Consul.

to the

189

Remarks.

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[NOTE. This form is to be used by Consular Officers residing at inland places in ieu of Form No. 101.]

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[NOTE.

This return to be sent at end of each quarter to the Auditor for the Sta and other Departments, with account for salary and fees.]

FORM NO. 104.

Power of attorney to verify invoices.

(Paragraph 673.)

I do hereby make, constitute, and appoint

of

my true and lawful attorney, for me, in my name, place, ar stead, to prepare any or all invoices of merchandise intended for export tion to the United States from in which I am or may be interest or concerned, and to take such oath or oaths, or to make and sign su declaration or declarations, as my duly authorized agent, which I mig do if I were personally present, in the manner prescribed by the laws the United States for the purpose of verifying invoices of merchandi in order to secure the requisite triplicate or quadruplicate certificat thereto; hereby ratifying whatever my said attorney may lawfully d under and by virtue of his power of attorney, in my behalf; and th authority, hereby conferred and delegated to said attorney, shall rema in full force until revoked by me by written notice on the U. S. Cons at

In witness whereof I have hereunto set my name and seal at

day of

189-.

Signed, sealed, and delivered in the presence of—

[SEAL]

Secretary of the Treasury.

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FORM NO. 105.

gregate return of fees at the Consulate of the United States at nd Consular Agencies connected with it, from

ive.

(Paragraphs 570, 586, 587.)

to

Fees for the quarter end

ing Sept. 30.

Fees for the
quarter end-
ing Dec. 31.

Fees for the
quarter end-
ing Mar. 31.

U. S. Consul.

NOTE.-This form is to be transmitted to the Department of State, with the blanks operly filled, at the close of the fiscal year (June 30).

FORM NO. 106.

orm of a consular account for compensation while receiving instructions.

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to

days, from

——, actually and necessarily occupied in receiving instructions, as per certificate hereto annexed, agreeable to Form No. 107...

Received payment.

To Hon.

DR.

U. S. Consul.

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