◆ SpookStack

jet en. bath ~ a 2 yop ar hoo. . rr Iie et yas tet eyes ®& Lt . EL MEO sats i cre aan! ee ene) ewe Oe es Ce eS vets INTERNATIONAL CERTIFICATE OF VACCINATION OR REVACCINATION AGAINS™ SMALE POX CERTIFICAT INTERNATIONAL DE VACCINATION OU DE REVACCINATION CONTRE LA VARIOLE Tris is ta certify that toe . . sax -_ Jo soussigne(a) certitie que Bowwit 3. Wit De & whase signature tollows . ‘ date of pirth . a : —_ neta} in _3 Z /¥? Govt la signature suit P has on the date indicated been vaccluated ar rekdccinated against smalipox with a freesmdried of tlavia vatcine certified to fuliill the recommended requirements of Lhe World Health Organization, a été vaccinefe) ou revaccine cante la variole 41a date indiguée cl-dessous, avec un vacein tyopniise au Nauide certifié conturme aux normes tecommandées par ('Organisalion mondiale de la Sanlé. —_ : - — 2a pee eae Show py "x | Signature, professianal Salus, and address |Orlginand Baten | Anprevert stamo wather of vaccinalor no. Of vaccine . we SO eee. Date . Inviaquer par Signature, qualité professionnede, at varessal Grigine duvoaecin Tachet S'U S'auit de Gu vaccinateur etnumergdulot | c'autrentificatlon la Primary vac- cination pw formed ("J Peimovacci- {'-7 nation — effecluce successful lb Keo as ) a 5 hoy Mrise ~ Pas de prise fi ‘ a — tee ree oa | -— + iW Reveccination “137 Sg Pec poe P ae Y AY ™ CALIFORNIA. ff MSA? {_] Revarcinahon CJ ' : Revaccination ; I eer a oe po —e “oes eee ee eee Revecchiatien i | : | a —. THE VALIDIADY OF FHS CERTIFICATE snail extena tor a periog of 3 years, beginning @ days afte: the date of a Successtul primary vaccination* or, in the event ol a cevaccinatinn, on the date of that revacciagtlon. The é¢pploved stamp onentioned IBoOve inst we in a form prescribed by the health administration of the country in which the vaceination is performed. . any armendingnt OF (his certilicute, Or erasuie, OF fadiice to Lormplele any purl of it, may render it Ing ad. LA VALIOITE BE CERTIFICAT couvre une poriode de trois ans commengant huit jours apras la date ce ta Prunovaccination effectu€e avec succes {prise) bu, dans le cas d'une revaccination, la jour de cette Fevaccinatian. _ Le cachet dWauinentilication doit ére contoraic au madcle Prescrit par Vadministration sanitaire du territalre Ou la vaccinstion est etfectuec, Toute correction Ou rature sur le certificat wi lomissian d'irnoe dueicongue des mentions au‘ compute puel afiector sa vaticdite, *See item 1. Instructions 10 Physicians