Page:United States Statutes at Large Volume 61 Part 2.djvu/211

 61 STIA.] INTER-AMIERICAN-AUTOMOTIVE TRAFFIC-DEC. 31, 1943 1167 INTERNATIONAL DRIVING LICENSE Issued in accordance with the provisions of the Convention on the Regulation of Inter-American Automotive Traffic signed at Washington, D.C., U.S .A ., in 1943. Issued by--.- -___________________________________ At - --- ---... _......__ ..... ___._._._.-- Date - ...- .- . . -. . --. -- - Signature (x) ..-- ....--- Number. -- -- -- _-___-.--_________ -____ (x) Signature of Authority or signature of Association empowered by the Author- ity, and "visa" of the latter. Valid for one year from date of issue. PARTICULARS CONCERNING THE DRIVER Photograph Official seal Surname. 1 Other names -- 2 Place of birth-_ --- 3 Date of birth --- _____-- --- _ 4 Home address--- --- .- - - - - - .. - - -- - - 5 (Name of country) REVOCATION M. (surname and other names)--- --. --- - _____________________ -- --- authorized as above by the authority of (country)-_ -_ ___ _ -- _____-- -- -- .-- -- - - is deprived of the right to drive in (country) - -- -- ________________-___.______________ by reason of---_ ___ __ .__________..______ Place. - -- . -- - . .. . . -. - - ............-- Date---. . . .. . . . (signature) Seal of Authority ---..-- PARTICULARS CONCERNING THE DRIVER For the photograph, see above (page 34) ['] Surname: - 1 Other names: --- ____. 2 Place of birth: ---.- 3 Date of birth: - .... . 4 Home address: 5 I[Supra.]

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