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de la Convention de l'Unión postale universelle et de l'article XXX du
Règlement de détail et d'ordre pour l'exécution de cette Convention.

EMPLOI D'UN TIMBRE-POSTE FRAUDULEUX

de

1 Nature l'envoi (lettre, échantillon, imprimé, papiers d'affaires, etc.).

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en vertu de l'article 18 de la Convention de l'Union postale universelle
et de l'article XXX du Règlement de détail et d'ordre pour l'exécution
de cette Convention, et assistant à la vérification d'

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1

à l'adresse

pesant..

Biffer, suivant le cas, l'une ou l'autre de ces indications.

et affranchi à raison de.

avons constaté que cet

envoi était revêtu d'un timbre-poste présumé frauduleux, ce qui constitue
la contravention prévue par l'article 18 de la Convention précitée.

q'uil refusait de faire connaître l'ex-
péditeur

Le destinataire nous a déclaré

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à l'effet de les transmettre à l'Administration des Postes de

De quoi nous avons dressé le présent procès-verbal en simple expédition pour qu'il y soit donné suit e conformément à l'article 18 de la Convention et à l'article XXX du Règlement susmentionnés.

Signature du destinataire

ou du fondé de pouvoirs.

Signature d..

des postes.

i

ADMINISTRATION DES POSTES D

K

TABLEAU STATISTIQUE

DU SERVICE POSTAL EN

ANNÉE 18

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() Les mots et boiles ont été omis, par erreur, dans la formule R annexée au Règlement signé.

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