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316 Socidtd des Nations - Recuel des Traitds. 1931 MODSLE NO 2 AD ARTICLE 4 DE LA CONVENTION. TRAFIC LOCAL DE FRONTISRE ENTRE LA POLOGNE ET LA ROUMANIE Laissez-passer permanent ......... RECTO N om et pr6nom s ........................................ ................................................................ P rofession ............................................................................................ ..................... Le titulaire (propri6taire, locataire, etc.) est autoris6 h exploiter des terres dans la commune de II est em ploy6 chez ...................................................................................................... Lieu de naissance .................................... date de naissance .......................................... N ation alit6 .................................................................................................................. D o m icile ..................................................................................................................... Lieu de passage de la fronti~re ................................................................................... V alable pour 6 m ois (un an) .......................................................................................... Photographie VERSO Signature du titulaire ............................................................................... .................... D6signation des mineurs de moins de quinze ans accompagnant le titulaire du laissez-passer ......... Lieu de d6livrance du laissez-passer .............................................................................. D a te ........................................................................................................................... Autorit6 ................. ........................ Sign atu re .............................................. Sceau officiel. No 2752
1931 League of Nations - Treaty Series. 317 FORM No. 2. AD ARTICLE 4 OF THE CONVENTION. LOCAL FRONTIER TRAFFIC BETWEEN POLAND AND ROUMANIA. Permanent Permit No ................... (FRONT.) Surname and Christian names ....................................................................................... O ccu p ation .................................................................................................................. The bearer (owner, tenant, etc.), is authorised to cultivate land in the commune of .................. H e is em ployed by ...................................................................................................... Place of birth ............................................. Date of birth .......................................... N ation ality .................................................................................................................. D o m icile ..................................................................................................................... Point at which frontier may be crossed ........................................................................... Valid for six months (one year) .................................................................................... Photograph of bearer. (BACK.) Sign ature of bearer ..................................................................................... . .............. Designation of minors under fifteen years of age accompanying the bearer of the permit ............ Place of issue of the permit .......................................................................................... D a te ........................................................................................................................... Authority ................................................ Signature ............................................. No. 2752 Official stamp.
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