Page:United States Statutes at Large Volume 41 Part 2.djvu/254

 IG94 PARCEL POST CON V'ENTION—CZECHO-SLOVAKIA. Ocmmm gf, 1919. Form. rom:. Data syamp ot Dis- (Country otorigin.) (Country ol destination.) Date stamp ol recclvgiugihxmlx g Parcels from for  %c:x Q pm { 1 Parcel Bill No. ., dated .. 19... I Q W S. S. ll-·-.11 Declared value oi the con- Num- E§0_ orrgmorpmu. Name anmuu. ddmssoiparoel. w°‘;gf;g“ 2;;;* ommum. _ the cus- paid mms deolarutions. Totals • When mh. .i..."‘°'° ""w.¤°“°,...,""°*" ‘:‘£.F"..,..1‘°’ ‘.§‘.??£.*i’,.‘:‘.£l’:¥°t2: *$§&2?¤‘i‘i.”°“· ‘° "‘" "° ‘““°““‘ Tok! ¤¤mbor of parcels sent by the mail to., Total weight or mnil --·--·-··· - ···-·-···-·- Doduct weight of receptacles. (Country of destination.) -——— N$b`:•i1r°¤fbox¤scrother mepmles tum- Nnwegnzapmn ,, “%.°‘?».°‘ mi.; '·**····*¤·* `'``````` Signature of postal official at the receiving exchange post office.
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