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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 this4 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.

Fee $2.50 United States gold, paid by affixing stamp to the duplicate copy of this document.

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

J W [[?]]
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 Harris Velten the undersigned, of2 168 New Bond St 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 anyone, 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, Mich in the United States of America.

Dated at LONDON, this 12th day of November 1907

6 H. Velten

PURCHASED BY IMPORTER.

Invoice No.} 28432
(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 November 12th, 1907.
Sellers Obach & Co
Address 168 New Bond St. W
Purchaser Charles L. Freer
33 Ferry Avenue Detroit, Mich
Name of Vessel ss Majestic
Port of Shipment, LONDON.
Port of arrival New York
Port of entry Detroit Michigan
Value £1715 
Contents Indo Persian paintings and books

LONDON, ENGLAND.
CUSTOM-HOUSE INDORSEMENT.*

No.

Importer
Vessel
From
Arrived

Kind of Entry:

Marks, Quantity, and Contents:

* 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.

Transcription Notes:
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