I,

FORM NO. 144.

Certificate of the value of currency.

(Paragraph 692.)

CONSULATE OF THE UNITED STATES AT

189-.

Consul of the United States of America, do hereby certify that the true value of the currency of the — of ——, in

which currency the annexed invoice of merchandise is made out, is per cent as compared with the corresponding standard coin currency, and that the value in such standard coin currency of the total amount of the currency actually paid for the merchandise is

FORM NO. 145.

(Omitted.)

FORM NO. 146.

Inward foreign manifest.

(Paragraph 700.)

Railroad.

U. S. Consul.

Report and manifest of merchandise laden on board car No.
Railroad, which merchandise was taken on board at

the

of

Consignor. Consignee.

[Indorsements.]

(1) United States Consulate at

fest No.

I,

Car No.

Quintuplicate consular mani

the undersigned owner (agent or consignee) of the merchandise laden on board, or conductor of car No. -, now about to depart, and destined for -, do solemnly swear (or affirm) that this manifest contains, to the best of my knowledge and belief, a full ani complete list and description of the contents of said car, and that the quantities and value of said contents are in this manifest faithfully and correctly stated.

Agent (or Conductor). day of, 189—

Subscribed and sworn to before me this And I hereby certify that this car was sealed and the manifest verified under my personal supervision.

U. S. Consul.

do certify that the sample hereto annexed is a fair and true sample of piece No., contained in the package No. above mentioned, and that the foregoing statement is in all respects true.

The certificate at the bottom is to be signed by the shipper or his agent.

I do hereby declare that the annexed sample is a fair and true sample

of piece No. contained in package No.

that the foregoing statement is in all respects true.

of firm of

above mentioned, and