Page:United States Statutes at Large Volume 59 Part 2.djvu/352

 TREATIES International Sanitary Convention for Aerial Navigation, 1944 INTERNATIONAL CERTIFICATE OF IMMUNITY AGAINST YELLOW FEVER THIS IS TO CERTIFY THAT (Age Sex ) whose signature appears below is immune to yellow fever as the result of an attack of the disease. This immunity has been demon- strated by the mouse protection test. Date of Dieedina Place of bleeding Name of Laboratory performing test- Location of Laboratory 'rnoo nf Tr.+ Signature of Laboratory Director_ (Signature of person tested) (Home address) Footnote: This certificate is not valid: (a) unless the Laboratory performing the blood test and the method employed have been approved by UNRRA; (b) for more than ten years from the date of the blood test. [59 STAT. Y"~ UE n, -,, l~of T'ort+ - -- ~UI Y1 - --- -- Official Stamp of Laboratory

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