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 -
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_......__ ..... ___._._._.-- 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
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PARTICULARS CONCERNING THE DRIVER For the photograph, see above (page 34) ['] Surname: --------------------------------------------------------- 1 Other names: -----------------------
____. 2 Place of birth: -------------------------------------------.--------- 3 Date of birth: -----
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. 4 Home address: ---------------------------------------------------- 5 I[Supra.]
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