I, J Jernegan, do solemnly, sincerely, and truly swear that
the within list contains the name of the crew of the Bk Roman
together with the places of their Birth and Residence, as far as I can ascertain the same.
swear this 27 day of October 1868
Before me collector. Jared Jernegan

I do certify, that the within is a true copy of the list of the crew of the

of whereof

is Master, taken from the original on file in this office.
GIVEN UNDER MY HAND AND SEAL OF OFFICE, at the Custom-House,
this day of, in the year
of our Lord one thousand eight hundred and

I DO HEREBY FURTHER CERTIFY, that the within named

who compose the company of the above mentioned whereof
is at present Master, have produced to me proof in the
manner directed in the act entitled "An Act for Relief and Protection of American Seamen."
And pursuant to the said act, and to the act supplementary to the act concerning Consuls and
Vice-Consuls, and for the further protection of American Seamen. I DO HEREBY CERTIFY, that the
said

are citizens of the United States of America.

GIVEN UNDER MY HAND AND SEAL OF OFFICE, this day

of, 18