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600

Owner's or Agent's Manifest of Articles exported by Railway. (365 Am. Ex. Co. June, 1903.) 

List or manifest of articles of domestic production or manufacture, and of foreign articles free of duty, or duty paid, delivered by [[blank]] (Name of Owner or Agent.) to American Express Co. at [[blank]] State of [[blank]] Agent [[blank]] (Name of Ex. Agent) For Exportation to M [[blank]] (Name of Consignee.) At [[blank]] (Name of place intended Destination in Foreign Country.) via [blank]] (Name of last port in United States. whence articles pass into the Foreign Country.)

[[eight column, eight row table]]

[[row one]]

|MARKS AND NUMBERS OF PACKAGES|PACKAGES AND CONTENTS WITH ARTICLES FULLY DESCRIBED|QUANTITIES, Lbs., Gallons, &c|NO.1 Value of DOMESTIC Merchandise|NO.2 Value of Foreign Merchandise FREE.|NO. 3 Value of Foreign Merchandise not from BONDED WAREHOUSE which has paid duties|NO.5 Value of Foreign Merchandise in Transit through the United States|

[[row two]]

|1|Box Judian Carves|[[blank]]|1995|[[blank]]|[[blank]]|[[blank]]|[[blank]]|

[[other rows blank]]

I, George H Pepper (Name of Owner or Agent.) hereby certify that the above is a full and true statement of the kinds, quantities values, and destination of all the articles delivered by me for exportation as aforesaid.

Residence, Am Marsam