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.

above mentioned, and

of firm of

FORM NO. 149.

Table for reducing United States gold coin to English and French currency.

I,

FORM NO. 150.

Certificate of consignee of landing of merchandise at foreign port.

of the

(Paragraph 724.)

of

merchant, do hereby certify that the goods or merchandise hereinafter described have been landed in this [city, town, or port] between the and

of, whereof

days of
is at present

from on board the master, viz: [Here describe the merchandise, giving the marks and numbers, kind of merchandise, number of pounds (gross, tare, and net), gallons (wine and proof), or packages upon which internal-revenue tax is imposed], which, according to the bills of lading for the same, were shipped on board the at the port of

in the United States of

, 189-, and consigned to [me aforesaid merchant [or by the mas

this

FORM NO. 151.

Consular verification of consignee's certificate.

(Paragraph 724.)

I, Consul [or agent] of the United States of America, at the city of do declare that the facts set forth in the foregoing declaration, subscribed by -, of said port, and dated the 189, are to my knowledge true and correct and deserv ing of full faith and credit; and I further certify that the signature thereto is in the handwriting of said

day of

In testimony whereof I have hereunto subscribed my name and affixed the seal of my office, at

[SEAL.]

FORM NO. 152.

Verification of the delivery of merchandise to be executed by American or foreign merchants, as the case may require.

We.

(Paragraph 724.)

day of

residing in the city of --, do declare that the facts stated in the preceding certificate, signed by of the said city, merchant, on the are [to our knowledge, just and true; or, are, in our opinion, just and true, and worthy of full faith and credit]. We also declare that there is [no Consul or other public agent for the United States of America, or American merchants, as the case may require] now residing at this place.

Dated this

We,

master, and

PORT OF

mate, of the

189lately

arrived from the port of in the United States of America, do solemnly swear [or affirm] that the goods or merchandise enumerated and described in the foregoing certificate, dated the day of 189-, and signed by

of the city of

, merchant, were actually - within the time specified in

delivered at the said port on board the the said certificate, and as to the tobacco and snuff described therein that the weight stated was ascertained by actual weighing at the time of delivery.

Master.

Sworn [or affirmed] at the port of 189-.

before me this

day of

[SEAL.]

1 NOTE. In all cases the oath of the master AND of the mate must be obtained. In the case of goods subject to internal-revenue tax the affidavit of the purser or other discharging officer may be substituted for that of mate.

In case of failure to execute the foregoing at the port of delivery of the goods, the same may, upon the return of the vessel at the port of shipment, be subscribed to before the collector of the port.

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-,' and their value ascertained to be and that the duties imposed by the

law in force in this country [or province] upon said goods have been paid, or secured to be paid:

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.