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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 this [[stamp]] 14 JUL 1909 [[/stamp]] day of January, A.D. 1904, 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 (equal to 10s. 4d.) paid by affixing stamp to the duplicate copy of this document.

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

B W Morris
Deputy United States Consul-General, London, England.

Directions.
1. Full names of Deponent
2. Address
8. Purchaser or "Seller."
4. Date.
5. Port.
6. Signature of Deponent.

[FORM No. 138.]
Declaration of Purchaser or Seller.

I, 1  David Croal Thomson the undersigned, of 2 1120 Pall Mass, London S.W.
do solemnly and truly declare that I am 3 with my partners, Seller of the merchandise in the within invoice mentioned and described; that he said invoice is in all respect correct and true, and was made at LONDON, whence said merchandise is to be exported to the United States; that said invoice contain 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 that which was actually paid or is to be paid for said merchandise. 

In Bond to Detroit

I further declare that it is intended to make entry of said merchandise at the port of 5 Detroit in the United States of America.
Dated at LONDON, this 13th day of July 1909.
6 D. Croal Thomson

PURCHASED BY IMPORTER.
Invoice No. } 18234

Here mark the forms "Original" "Duplicate" & "Triplicate" respectively ☞ Quadruplicate
Issued in } Triplicate Quadruplicate.

Consulate-General of the United States, AT LONDON, ENGLAND.
Date 13th July, 1909.
Sellers Wallis & Son
Address 1620 Pall Mall London
Purchaser Chas L. Freer 
33 Ferry Ave, Detroit, Michigan USA
[[strikethrough]] Name of vessel [[/strikethrough]] per American Express Co. 
Port of Shipment, LONDON
Port of arrival New York
Port of entry Detroit
Value £ 3000 - 0 - 0
Contents Oil paintings & gold frames

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.