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I hereby certify that I know the above-named

person

ally, and know h-to be the of the person referred to in the withindescribed certificate of naturalization, and that the facts stated in haffidavit are true to the best of my knowledge and belief.

[Address of witness.]

Applicant desires passport sent to following address:

FORM No. 179.

Certificate of deposit of passport and registry of a citizen of the United

States.

(Paragraph 165.)

CONSULATE OF THE UNITED STATES OF AMERICA, At

Age
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Forehead

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The undersigned Consul of the United States of America, certifies that a citizen of the United States of America, is registered in this consulate, and is the bearer of passport No.

-, signed by

No.

[Signature of the bearer.]

FORM NO. 180.

(Paragraph 166.)

Certificate to be attached to a passport application in China when a notary public or other officer authorized to administer oaths is not accessible to the applicant.

I, the undersigned, do hereby certify and affirm that the matters stated in my application for a passport of date are true; and I do hereby consent that this statement shall, in all respects, be held and treated as if I had personally executed such application before a consul of the United States.

Witness:

FORM NO. 181.

(Paragraph 167.)

Travel certificate to be issued to the possessor of a passport in China.

No.

I,

-.]

Consul of the United States of America at

having received an application from

a citizen of the United States, for a passport to travel in the province of have, under the provisions of the Tien Tsin treaty, issued this pass, and have to request that the Chinese authorities, civil and military, on examining it, will allow Mr. safely and freely to pass, and in case of need, to

give him all lawful aid and protection.

Given under my hand and the impression of the seal of the consulate

of the United States at

Good for one year.

[SEAL.]

this day of

189-.

U. S. Consul.

FORM NO. 182.

(Paragraph 167.)

Travel certificate to be issued to an applicant for a passport in China.

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having received an application from a citizen of the United States, for a passport to travel from --, by way of, —, to [and return], have, under the provisions of the Tien Tsin treaty, issued this pass, and have to request that the Chinese authorities, civil and military, on examining it, will allow Mr.

safely and

freely to pass, and, in case of need, to give him all lawful aid and protection. Given under my hand and the impression of the seal of the consulate of the United States at this day of 189-. Good only for one journey, and not longer than one year. [SEAL.]

U. S. Consul.

FORM No. 183.

Affidavit of consignee, declaring the delivery of tobacco or snuff at a

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of -

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do hereby declare that the goods or merchandise hereinafter described have been landed at this port, between the days of -, from on board the whereof

and

is at present master, viz:

of

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Which goods or merchandise, according to the bills of lading for the same, were shipped on board the

at the port of ——, in the

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further certify that the weight of the goods as stated above was correctly ascertained by actual weighing after landing.

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I,

Certificate of consignee of landing outside of free zone.

(Paragraph 728.)

of the city of

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-, Mexico, do hereby certify that he goods or merchandise hereinafter described have been landed in the ity of

are of the

--, Mexico, on the day of

railroad, whereof

189-, from on board the - is at present conductor,

nd have been duly entered at the Mexican custom-house in the said city f ——, and consigned, forwarded, and delivered to Mexico, beyond the limits of the free zone.

at

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Marks.

Numbers.

Description of goods.

Value.

'hich, according to the bills of lading for the same, were shipped on oard the bonded line at the port of -, in the United States of merica, on the 189-, and consigned to me at

[exico, by

day of
of

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Consignee.

I,

the city of

FORM NO. 185.

Consular verification of consignee's certificate.

(Paragraph 728.)

Consul (or agent) of the United States of America at do declare that the facts set forth in the preceding

certificate, subscribed by

dated the

day of

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, are, to my knowledge, just and true or are, in my opinion, just and true, and deserve full faith and credit). In testimony whereof I have hereunto subscribed my name and affixed the seal of my office, at day of, 18—.

this

[SEAL.]

U. S. Consul.

FORM NO. 186.

Certificate of record and pedigree to be used for imported animals,

(Paragraph 705.)

[In filling up this blank give registry number of each recorded animal, or, in case there is no number, the volume and page of register where the animal is recorded. All blanks must be filled, except in the case of sheep, which animals will be admitted on the certificate of registry, as provided in the regulations.]

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No

I hereby certify that the above is a correct pedigree of and that this animal is pure bred and has been duly registered in the book of record established by this association for the

breed

of

Dated at

Secretary of the

189-.

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