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.

No.

I,

Consul of the United States of America at

a citizen of the

safely and

having received an application from 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. 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.]

FORM No. 183.

U. S. Consul.

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

of

I,

do hereby declare that the goods or merchandise hereinafter described have been landed at this port, between the whereof

and

of

days of
from on board the
is at present master, viz:

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

in the

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

I,

Certificate of consignee of landing outside of free zone.

(Paragraph 728.)

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

care of the

--, Mexico, on the day of

railroad, whereof

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

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

which, according to the bills of lading for the same, were shipped on board the bonded line at the port of

in the United States of 189, and consigned to me at

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 of the said city, merchant, and

certificate, subscribed by

dated the

day of

, 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.]

I hereby certify that the above is a correct pedigree of —— No. —, 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-.

Form of Consular authentication of the certificate of record and

pedigree.

CONSULATE OF THE UNITED STATES,

of the

I certify that the foregoing is the signature of he is the

—, and as such is the custodian of the book of record and pedigree established by that association for the breed of

[L. S.]

FORM NO. 187.

U. S. Consul.

Affidavit by the owner, agent, or importer.

(Paragraph 705.)

being duly sworn, says, that he is the (owner, agent, or
described as follows in

importer, as the fact may be) of the
invoice No. -
on the

certified by the Consul of the United States at

day of -, 189-: [Insert description precisely as given in the invoice]; that the said

is the animal referred to in the accompanying certificate of record and pedigree, and is about to be imported to the United States specially for breeding purposes in accordance with the terms of the said invoice.