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: ______________________________