on the date of
are the products of the United States of America.
|MARKS AND NUMBERS||NO.OF PKGS.
BOXES OR CASES
WEIGHT IN KILOS
|COMPLETE AND ACCURATE DESCRIPTION OF GOODS|
These commodities, technology or software were exported from the Unites States in accordance with the Export Administration Regulations. Diversion contrary to United States law prohibited.
Sworn to before me this day of
Dated at on the day of
(Signature of Owner Agent)