ANTIQUE STATEMENT

 

 

 

 

I HEREBY CERTIFY THAT THE ITEMS IN THIS SHIPMENT IMPORTED ON FEDERAL EXPRESS

AIR WAYBILL NUMBER______________________________ ARE 100 YEARS OLD OR OLDER.

 

 

 

 

CIRCA____________________________________

 

 

 

SIGNED_________________________________________

 

 

 

 

NOTE:  CIRCA REPRESENTS THE ERA IN WHICH THE ITEM WAS MANUFACTURED.

              SOME EXAMPLES OF CIRCA ARE “1872” OR “THE 1930s”.

 

 

 

 

RETURN TO: ______________________________