I,

FORM No. 144.

Certificate of the value of currency. (Paragraph 662.)

Consul of the United States of America, do hereby
of
in which
cents,

certify that the true value of the currency of the
currency the annexed invoice of merchandise is made out, is
estimated in United States gold dollars.

FORM No. 145.

Declaration to be made by the owner or manufacturer, where goods have been procured otherwise than by purchase. (Paragraph 654.)

I,

of

in the county of, do solemnly and truly declare that I am the [owner or manufacturer] of the goods, wares, and merchandise in the annexed invoice mentioned and described, and that said invoice is in all respects true; that it contains a true and full statement of the actual market-value of such of the said goods, wares, and merchandise as are subject to any ad valorem rate of duty, or to any duty regulated or directed by law to be estimated or based upon the value of the square yard, or of any other specified quantity or parcel, at the time and place when and where the same were procured or manufactured; of the actual quantity of said goods, wares, and merchandise, and of all charges thereon; that no discounts, bounties, or drawbacks are contained in said invoice, except such as have been actually allowed thereon; and that no invoice different from the one now produced has been or will be furnished to any one.

I further declare that it is intended to make entry of said goods, wares, and merchandise at the port of ——-—, in the United States of America. And I make this solemn declaration, conscientiously believing the same to be true, and by virtue of the provisions of an act made and passed in the fifth and sixth years of the reign of His Majesty King William the Fourth, intituled "An act to repeal an act of the present session of Parliament, intituled an act for the more effectual abolition of oaths and affirmations taken and made in various departments of the state, and to substitute declarations in lieu thereof, and for the more entire suppression of voluntary and extrajudicial oaths and affidavits, and to make other provisions for the abolition of unnecessary oaths."

A Commissioner to administer oaths in chancery in England,
and to take declarations in lieu of oaths.

NOTE. This form is to be used in Great Britain when the declaration is made before a commissioner, whose qualification must be certified by the consul. If the oath or declaration is made before a justice of the peace, notary public, or other competent officer, the proper term should be used instead of commissioner.

FORM No. 146.

Declaration, under oath or affirmation, to be made by the owner, agent, or consignee of merchandise, or conductor of a railroad car, to manifest of merchandise imported from foreign territory contiguous to the United States. (Paragraph 670.)

I, A B, owner (agent or consignee) of the merchandise laden on board, or conductor of (here insert the name of the railroad company) car, numbered, now about to depart, and destined for (the port of destination), do solemnly swear (or affirm) that this manifest contains, to the best of my knowledge and belief, a full and complete list and description of the contents of the said car, and that the quantities and value of said contents are in this manifest faithfully and correctly stated.

Subscribed and sworn (or affirmed) to before me this

188-.

day of

Consular No. of the invoice.

Marks and No. of the packages.

Name of the shipper.

Name of the consignee.

Kind of merchandise.

Width of merchandise.

Invoiced price.

Discount.

Date of the invoice.

No.

Remarks.

FORM No. 147.
Sample card. (Paragraph 650.)

do certify that the sample hereto annexed is a fair and true sample of piece contained in the package No.

statement is in all respects true.

above mentioned, and that the foregoing

FORM No. 149.

FORM No. 150.

Certificate of consignee of landing of merchandise at foreign port. (Para

I,

of the

graph 681.)
of

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

of

whereof

is at present master, viz: [Here describe the merchandise, giving the marks and numbers, kind of merchandise, number of pounds (gross, tare, and net), gallons (wine and proot), 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 America, day of 13, and consigned to [me or to us], aforesaid merchant [or by the master of said

on or about the

by

-].*

of

Given under my hand, at

Consular verification of consignee's certificate. (Paragraphs 681 and 685.)

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 day of 18-, are, to my knowledge, true and correct, and deserving of full faith and credit; and I further certify that the signature thereto is in the handwriting of said

In testimony whereof, I have hereunto subscribed my name and affixed the seal of my office, at 188-.

[SEAL.]

this day of

Consul.

* In cases of shipment of tobacco or snuff in bond, under sec. 24 of the act of Febru ary 8, 1875, the following will be added: "And I further certify that the weight, as above stated, was correctly ascertained by actual weighing after landing." In all such cases the foregoing certificate must be sworn to before a United States Consul, Vice-Consul, or Agent at the port, or, in their absence, before an officer qualified to administer oaths and having a seal, by the consignee to whom the merchandise is actually addressed. The columns for marks, numbers, weight, gallons, serial number of stamps, &c., as the case may require, must accord with the regulations governing the particular exportation.