Page:United States Statutes at Large Volume 48 Part 2.djvu/269

FRIENDSHIP, ETC., TREATY-POLAND. JUNE 15, 1931. No. (Enclosure 1) No. of the institution executing the certificate of origin. Certificate of origin I, (member or manager of the firm or corporation) _____________ _ (name of individual and title) exporter of the merchandise described below, do solemnly and truly declare that the said merchandise has been finished in the lis the growth of I has been manufactured in 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 Unit.ed States, and that the said merchandise is correctly described as follows: Port of shipment ____________________________ .. ______________ _ On steamship ______________________________________________ _ (name of steamship) Name of shipper ___________________________________________ _ (indicate whether merchant or manufacturer Address of shipper _________________________________________ _ Consignee in Poland ________________________________________ _ Address of consignee in Poland ______________________________ _ Dated___________________ _ Marks and numbers No. of packages Description of tho Weight Value or cases commodities Gross Net ____________________ SignatureofExporter Subscribed and sworn to before me this __________ day oL ______ _ __________ 19____ ____________________ Notary Public CERTIFICATION BY CHAMBER OF COMMERCE ____________________ 19____ A Recognized Chamber of Commerce has exaInined the manufacturers invoice or shippers affidavit concerning the origin of the merchandise, and according to the best of its knowledge and belief, finds the products named originated in the United States of America. (Signature and seal of the Institution executing the Certlll.cate of Origin) (Certification of competent Polish Consular Officer) 1541