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Mercury Air Freight B 7841

CARC SERVICE BLDG #80
N.Y. INTERNATIONAL AIRPORT
JAMAICA 30, NEW YORK

OLympia 6-5400

ADS 65400
CUSTOMS HOUSE LIC. 1246
[[3 column table]]
| FOR THE ACCOUNT OF | REFERENCE | DATE |
| CASH | NAC 377859 | 10/29/63 |
| PICK UP AT | DELIVER TO |   |
| SHIPPER | CONSIGNEE [[?]] [[?]] |   |
| ADDRESS | ADDRESS 33E74 | P. U. DRVR. |
| ATTENTION | ATTENTION | DEL. DRVR. |

LIABILITY LIMITED TO $100.00 UNLESS GREATER VALUE DECLARED PURSUANT TO AGREEMENT ON REVERSE SIDE

Declared Value $

Shipper's Signature
[[7 column table]]
| NO. OF PIECES | DESCRIPTION AND MARKS | WEIGHT | RATE | PREPAID | CHARGES | COLLECT |
| 1 | Box | 64 |   |   | OUR CHARGES |   |
|   |   |   |   |   | ADVANCES |   |
|   |   |   |   |   | Exess Value C.O.D. Fee |   |
|   |   |   |   |   |   |   |
|   |   |   |   | X X X | C. O. D. |   |
|   |   |   | CASH | COLLRS | TOTAL | 1606 |

Rec'd in Good Order and Condition, Except as Nooted.

Drivers Must Collect All Charges Unless Credit Is Authorized by Mercury.

MERCURY AIR FREIGHT

Rec'd in Good Order and Condition, Except as Noted.

By:

Consignee:

By:

FORM T-114-1A 15M 7/64 ORIGINAL: DELIVERY RECEIPT (RETURN TO MERCURY) DUPLICATE: CONSIGNEE COPY TRIPLICATE: CONSIGNOR COPY

ATLAS BUSINESS FORMS