This document is from the personal collection of Daniel Supplice. The last time I was in Port-au-Prince, a friend introduced me to Daniel and he kindly let me look at and photograph his collection.
This document, dated 27 Brumaire an XII, Au Cap (19 November 1803 – the date of the evacuation of the French from Le Cap), contains part of the longer proclamation discussed by David Geggus in his post on its publication in The Times, London.
This version of the first Declaration of Independence has three additional signatures: Alexandre Petion, Andre Vernet, and Francois Cappoix (in addition to Jean-Jacques Dessalines, Henry Christophe, and Augustin Clerveaux).