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[Note from transcriber: This document is a pre-printed form, with blanks filled in by hand. Pre-printed words are in curly brackets, so: { } ]

[At left]
Victoria
of
Boston
for
Sable Island

{Shipped, in good order and condition, by} R.B. Forbes
{on board the good} Brig {called the} [crossed out: Halifax] "Belle" {whereof} [blank] {is Master, for this present voyage, now lying in the Port of Boston, and bound for} Halifax

One life Boat fitted with outside
and inside floats, - five Bars. -
two pair of Bellows, - four Buckets.
casting line, painter.

{being marked and numbered as in the margin, and are to be delivered in like good order and condition, at the aforesaid Port of} Halifax {(the danger of the seas only excepted,) unto} The Hon.ble John Howe. P.S. {or to Assigns, he or they paying Freight for the said Goods} To be settled by the Agents in Halifax [crossed out: and Boston Wharfage], with} out {Primage and Average accustomed. ¬— IN WITNESS WHEREOF, the Master of the said vessel hath affirmed to} three {Bills of Lading, all of this tenor and date; one of which being accomplished, the others to stand void.}

{Dated at BOSTON}
December 14th {185}3
[signature] [G.B. Sampson?]