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I,

FORM NO. 154.

Certificate of foreign revenue officer.

(Paragraph 725.)

PORT OF

189-.

do hereby certify that the goods [or merchandise] described in the foregoing declaration, and below, imported into this country [or province] from were landed at this port, duly entered at the custom-house at this port on the day of, 189—‚1 az.d their value ascertained to be

law in force in this country [or paid, or secured to be paid:

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and that the duties imposed by the province] upon said goods have been

Marks.

Numbers.

Description of goods. Date when entered.

at

In witness whereof I have hereunto set my hand and seal of office this

day of [SEAL.]

I,

189-.

Collector or Chief Revenue Officer.

FORM NO. 155.

Form of declaration of American artist.

(Paragraph 711.)

a citizen of the United States and an artist residing"

do solemnly and truly declare that the work [or works] of art mentioned and described in the within invoice was [or were] executed and produced by me.

Subscribed and sworn to [or affirmed] before me this

189-.

day of

U. S. Consul.

1 NOTE. The value stated should be that of the goods in the foreign country to. which they were exported. Such value need not be specified if the consignee chooses to pay the maximum fee for the Consular authentication of the landing certificate.

I,

Certificate to the declaration of an American artist.

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

who is known to me to be a citizen and and that the statements therein are true to

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

U. S. Consul.

I,

FORM NO. 156.

Certificate to accompany natural mineral waters.

of

(Paragraph 708.)

do hereby declare under oath that I am the owner [or manager] of [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.

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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.

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I,

FORM NO. 158.

Certificate of United States Consul to manifest of fishing vessel.

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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

-, master of

the ——, 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

[SEAL.]

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issued at the port of

commanded b [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

189-.

day of

No.

Date.

(Paragraphs 488, 586, 587 )

To whom the serv Nature of the Amount of fee or
ice was rendered. service. compensation.

Remarks.

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.

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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

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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 or some other competent adjuster

at the of of marine losses.

of

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 repre

sentative 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

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.

To be filled out by signer of the bond.

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