+---------------------------+------------------+ |Name and official number | | |of ship. | | +---------------------------+------------------+ |Port of registry. | | +---------------------------+------------------+ |Tonnage. | | +---------------------------+------------------+ |Description of voyage or | | |employment. | | +---------------------------+------------------+ |Name of seaman. | | +---------------------------+------------------+ |Place of birth. | | +---------------------------+------------------+ |Date of birth. | | +---------------------------+------------------+ |Character. | | +---------------------------+------------------+ |Declines to give statement | | |of character. | | +---------------------------+------------------+ |Capacity. | | +---------------------------+------------------+ |Date of entry. | | +---------------------------+------------------+ |Date of discharge. | | +---------------------------+------------------+ |Place of discharge. | | +---------------------------+------------------+ I certify that the above particulars are correct, and that the above-named seaman was discharged accordingly. Dated ———— day of ————, eighteen hundred and ————. (Signed) ———— ————, Master. (Countersigned) ———— ————, Seaman. Given to the above-named seaman in my presence this ———— day of ————, eighteen hundred and ————. (Signed) ———— ————, Shipping-Commissioner. (R. S., 4612.) Naturalization and citizenship of seamen.