Viewing page 20 of 48

This transcription has been completed. Contact us with corrections.

Secretary of 
Foreign Affairs.

--

Department
of Orders and Nobility.                           Order of Leopold 

---                                                      ---
In the year                        Acknowledgment of the receipt of the decoration.
Royal decree of

I, the undersigned, have received from the Secretary of Foreign Affairs the insignia of Officer in the Order of Leopold, which shall be returned in case of promotion.

To.................... the ...............191

Name           Rank                  Date and place of birth and address

        Civil or Military functions. 
  
                                       Born 
                                       in 
                                       State of 
                                       address
            ...........................

N. B. It is requested that the present acknowledgment of the receipt of the Order be sent to the Secretary of Foreign Affairs, after it has been completed and legibly signed and that, in case of promotion, the insignia of inferior rank be included.