Form K. No.

Know all men by these presents, That we,

are held and firmly bound unto the United States of America in the sum of dollars, for the payment of which, well and truly to be made, we bind ourselves, our heirs, executors and administrators, jointly and severally, by these presents, by us subscribed, and sealed with our seals, this day of one thousand eight hundred and

The condition of this obligation is such, That if the above bounden , or either of them, or either of their heirs, executors, administrators or assigns, shall indemnify the Government of the United States of America, the collector of the port of , and any other officer or officers of the customs, of the said port, against any claim upon said Government, collector or other officer or officers, for the loss of, or for any decay, waste or damage, that may happen to any goods, wares or merchandise, that now are, or hereafter may be stored, under the warehouse act of August 6, 1846, and Treasury Instructions under said act, in the store or premises known as street, natural decay or unavoidable waste or damage, and loss or damage by fire, alone excepted, then this obligation to be void, otherwise to remain in full force and virtue.

Sealed and delivered in presence of

[SEAL.]