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Charles L. Freer,
$ 4.10 [[checkmark]] 
No. 38 [[checkmark]]
IN FAVOR OF W. H. Allison, [[checkmark]] Detroit.
Month of January, 1904 190

CHARGE
Art, [[checkmark]] 4 10 [[checkmark]]

Paid [[stamp]] FEB 2 1904 [[/stamp]] 190
Vou. Reg. Page 44 
Check No. [[checkmark]] S 6519
THE RICHMOND & BACKUS CO., DETROIT.

PURCHASED BY IMPORTER.
Invoice No. } 1115
(leave blank.)

Here mark the forms "Original," "Duplicate," & "Triplicate" respectively:
Duplicate

Issued in } [[strikethrough]] Triplicate. [[/strikethrough]] Quadruplicate.

Consulate-General of the United States, AT LONDON, ENGLAND
Date 19 January, 1904
Sellers John Yockney
Address 5 Regent St. S.W
Purchaser Charles L. Freer
Name of vessel Majestic
Port of Shipment, LONDON.
Port of arrival New York
Port of entry Detroit
Value £224-15-6
Contents one framed pastel

LONDON, ENGLAND.
CUSTOM-HOUSE INDORSEMENT.
No.
Importer
Vessel
From
Arrived
Kind of Entry:
Marks, Quantity, and Contents: E O

*Consular officers will leave all of above indorsement blank.  It is to be filled in only at the custom house at the port of entry.