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20,000 24-7-1902.  All Blanks in these Three Columns to be filled in by Shipper. The form of Invoice on the other side to be used.

[Form No. 140.]

CONSULAR CERTIFICATE.

I, the undersigned, Deputy-Consul-General of the United States, do hereby certify that, on this  day of  , A.D. 190 , the invoice described in the indorsement hereof was produced to me by the signer of the annexed declaration.

I do further certify that I am satisfied that the person making the declaration hereto annexed is the person he represents himself to be, and that the actual market value or wholesale price of the merchandise described in the said invoice in the principal markets of the country at the time of exportation is correct and true, excepting as noted by me upon said invoice, or respecting which I shall make special communication to the proper authorities.

Witness my hand and seal of office the day and year aforesaid.

Received the equivalent of $2.50 in gold.

[[??]]
Deputy United States Consul-General, London, England.

Directions.

1. Full names of Deponent.
2. Address,
3. 'Purchaser or "Seller"
4. Date.
5. Port.
6. Signature of Deponent.

[Form No. 138.]

Declaration of Purchaser or Seller.

I,1 Gus Mayer the undersigned, of2 168 New Bond Street W. do solemnly and truly declare that I am3 Seller 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 LONDON, 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, price actually paid or to be paid therefor, 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 in said 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 or is to be paid for said merchandise.

I further declare that it is intended to make entry of said merchandise at the port of5 Detroit-Michigan in the United States of America.

Dated at LONDON, this 25th day of May, 1906.

6 Gus Mayer 

PURCHASED BY IMPORTER.
12320

Invoice No.} (leave blank.)

Here mark the forms "original," "Duplicate," & "Triplicate" respectively: quadruplicate 

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

Consulate-General of the United States,
AT
LONDON, ENGLAND.

Date May 25th, 1906.
Sellers Obach at -
Address 168 New Bond St. W.
Purchaser C. L. Freer Esq.
33 Ferry Avenue, Detroit
Name of vessel SS Philadelphia
Port of Shipment, LONDON.
Port of arrival New York.
Port of entry Detroit
Value £ 50
Contents Etched Copper plates by an American Artist

LONDON, ENGLAND.
CUSTOM-HOUSE INDORSEMENT.*

No.

Importer
Vessel
From
Arrived

Kind of Entry:

Marks, Quantity, and Contents:

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