Page:United States Statutes at Large Volume 48 Part 2.djvu/266

 1538 FRIENDSHIP, ETC., TREATY-POLAND. JUNE 15, 1931. Certlftcate of origin, [Enclosure 2) Indirect ahlpments. Place and date CERTIFICATE OF ORIGIN ~e (consignor of the goods) _________________________________ _ ---(~;~;d~M;,th;~)­ exporter(s) of the merchandise described below, do solemnly and U s the growth of } truly declare that the said merchandise has been finished in has been manufactured in the United States of America, and that not less than 50 per cent of the total value of the goods represents the cost of labor and raw material in the United States, and that the said merchandise is correctly described as follows: Marks and numbers No. of packages or Description of com- Weight Value cases moditles Gross Net The above described merchandise is to be shipped per___________ _ (indicate wheth8l' on steBIIl8hlp (name) or by railway) from ___________________ _ (place of shipment) Consignee in the Polish custom territory ________________________ _ Address of consignee in the Polish custom territory _______________ _ Signature of consignor. Certification by the competent cons\llar authority of the U.S.A. No. _____________________ _ (of the consular re~ntatlve 081' - tlfyilll the oert11lcate of origin) --- ___ __ ___ _ 19____ (Place and date) I do hereby certify, that I have examined the documents concerning the merchandise described above by the consignor, and according to my best knowledge and belief, I find the products named originated in the United States of America. Witness my hand and seal of office the day and year aforesaid. - ___________________ of the United States of America. (Certification by the competent Polish consular representative).