I certify that an examination of the records of the Commissioner's Office shows the following facts as to the assessment and payment of the tax:

I certify that the records of my office show the following facts as to the purchase of stamps:

This deponent being duly sworn according to law, deposes and says that this claim is made on behalf of the claimant named above, and that the facts stated below with reference to said claim are true and complete:

1. Business engaged in by claimant

2. Character of assessment or tax..

3. Amount of assessment

4. Amount now asked to be abated

Deponent verily believes that the amount stated in item 4 should be abated, and claimant now asks and demands abatement of said amount for the following reasons:

(This affidavit may be sworn to before a Deputy Collector of Internal Revenue without charge.)

I certify that an examination of the records of the Commissioner's Office shows the following facts as to the assessment and payment of the tax:

This deponent being duly sworn according to law, deposes and says that this claim is made on behalf of the claimant named above, and that the facts stated below with reference to said claim are true and complete.

Deponent verily believes that the amount stated in item 4 should be credited, and claimant now asks and demands credit of said amount for the following reasons:

(This affidavit may be sworn to before a Deputy Collector of Internal Revenue without charge.)

I certify that an examination of the records of the Commissioner's Office shows the following facts as to the assessment and payment of the tax: