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(Form No. 138.)

Declaration to be Indorsed on the Invoice and Signed by the Purchaser or Duly Authorized Agent of such Purchaser, where Merchandise has been Actually Purchased.

I, J.A. Stoneham, of Bombay, do solemnly and truly declare that I am the* Agent of Owner of the merchandise in the within invoice mentioned and described; that the said invoice is in all respects correct and true, and was made at✝ Bombay, whence said merchandise is to be exported to the United States; that said invoice contains a true and full statement of the time when, the place where, and the person from whom the same was purchased, and the actual cost thereof, and all charges thereon; that no discounts, bounties, or drawbacks are contained in said invoice but such as have been actually allowed thereon; that no different invoice of the merchandise mentioned inside invoice has been or will be furnished to any one, and that the currency in which said invoice is made out is that which was actually paid for said merchandise. And I further declare that it is extended to make entry of said merchandise at the port of New York, in the United States of America.

p p Latham Co
J. A. Stoneham

*Purchaser or owner, or agent of purchaser or owner.
✝ Name the place from which the merchandise is to be exported to the United States.