Date. Place. Causest)

or of Death.
of leaving this Ship,
Date, Place, and Cause

18

tion of any Member of his Crew.

the Discharge, Death, or DeserTo be filled in by the Master upon

CHARGE, &c.,

20

We, the undersigned Members of
the Crew of this Ship, do hereby
release this Ship, and the Master
and Owner or Owners thereof, from
all Claims for Wages, or otherwise
in respect of this Voyage, and I, the
Master, do hereby release the said
undersigned Members of the Crew
from all Claims in respect of the
said Voyage.
Signatures of Crew (each to be on the
Line on which he signed in Col. 1).

Signatures or Initials of Official before whom the Balance of Wages was paid, Release signed, and Date.

Reference No.

RELEASE (late M).