234 rJUREAU OF ENTOMOLOGY AND PLANT QUARANTINE TTuly-Sept. 
PRESCRIBED CERTIFICATE 
The undersigned (full name, official title, and address) hereby certifies that 
he has inspected the shipment described hereafter, and that it does not contain 
seeds, plants, or parts of plants of indigenous oaks {Qnercus pedunculata, 
Q. roJ)U7\ or Q. sessilifloi'a) . 
Der Unterzeichnete , bescheinigt hiermit, dass die 
nachstehend beschriebene Sendung von ihm untersucht ist und Samen, Pflanzen 
Oder Pflanzenteile einschliesslich der Samen enthaltenden Fruchtstande der 
einheimischen Eichenarten (Quercus pedunculata and Q. sessili/lora) nicht 
enthalt. 
Description of Shipment 
Besclirei'bung der Sendung 
Kind of seeds 
Art der Samen 
Number and kind of packages . 
Anzahl und Art der Packstiicke . 
Mark and number of shipment 
Zeichen und Nummer der Sendung 
Weight of shipment 
Gewicht der Sendung 
Place of origin 
Ursprungsort 
Name and address of shipper 
Name und Anschrift des Absenders 
Name and address of consignee 
Name und Anschrift des Empfangers . 
Place and date 
Ort und Datum 
[official seal] 
[dienstsibqel] 
Name of the competent authority. 
Name des amtlichen Sachverstandigen. 
Official station of competent authority. 
Dienststellung des Sachverstandigen. 
In view of the fact that rooted plants, whose importation into Germany is 
not prohibited by special quarantines, and which proceed from countries (includ- 
ing the United States) that do not adhere to the International Phylloxera Con- 
vention, must be accompanied by a shipper's ^ declaration in German obligating 
himself to pay the cost of inspection of such plants for phylloxera and commis- 
sioning tlie consignee or other person authorized by the shipper and residing in 
Germany to pay that cost, a model form of such a declaration is offered below 
in English and German. 
shipper's obligation to pay the cost of inspection 
The undersigned (full name and address) hereby obligates himself to bear 
the cost of inspection of the shipment described below and commissions the 
consignee of the shipment or other authorized person residing in Germany to 
pay such expenses. 
Der Unterzeichnete, , verpflichtet sich hiermit 
zur Tragnng der Kosten der Untersuchung der unten beschriebenen Sendung 
und beauftragt den Empfanger der Sendung oder einen im Reichsgebiet 
wohnhaften Bevollmachtigten des letzteren zur Entrichtung solcher Kosten. 
2 See subpar. {I) of par. 2, p. 2, of circular B. E. P. Q. 405. 
