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| Title | Supposed Liable to Customs Duty |
| FormNumber | B |
| Revision | |
| Division | |
| WhereUsed | affixed to packages upon arrival in the U.S. |
| EKU | 9 February 1911 |
| LKU | |
| Notes | Contributed by G. Taylor
"L" is omitted in the word "located" and visible damage to the letter "o" |
| Source | SS |
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