Page:United States Statutes at Large Volume 59 Part 2.djvu/350

 TREATIES [59 STAT. International Sanitary Convention for Aerial Navigation, 1944 INTERNATIONAL CERTIFICATE OF INOCULATION AGAINST CHOLERA TTTTR T n T'P ('RPT 'V 'FTTTAT (Age Sex ) whose signature appears below was on the dates indicated inoculated against cholera. Material Inoculating Officer Date BOrigin atch No. and Tye Signature Official Title _____________________ -I________ _________ ________ _______________-_ (Signature of person inoculated) (Home address) (Date) Official Stamp of Inoculating Officer (This certificate is not valid for more than 6 months from date of issue.) 1016 wLI~ llJ AD VVA:1W1' Xs s

�