Contadora

DEPARTMENT OF THE TREASURY
UNITED STATES CUSTOMS SERVICE

NORTH AMERICAN FREE TRADE AGREEMENT
CERTIFICATE OF ORIGIN Customs Form 434 (121793)
Approved through 12/31/96
OMB No. 1515-0204
Seeback of form for Paper-
Work Reduction Act Notice.

Please print or type 19 CFR 181.11, 181.22
1. EXPORTER NAME ANDADDRESS 2. BLANKET PERIOD (DD/MM/YY)

HERRMANN ULTRASONICS, INC.
1261 HARDT CIRCLE FROM 01/01/2010
BARTLETT, IL 60103
U.S.A. TO 31/12/2010
TAX IDENTIFICATION NUMBER: 36-3677459
3.PRODUCER NAME AND ADDRESS 4. IMPORTER NAME AND ADDRESS
HERRMANN ULTRASONICS, INC. Productos Internacionales Mabe SA de CV
1261 HARDT CIRCLE Av. San Pablo Xochimehuacan 7213
BARTLETT, IL 60103COL. La Loma Puebla
Puebla, MEXICO C.P. 72230
U.S.A. MEXICO
TAX IDENTIFICATION NUMBER: 36-3677459 TAX IDENTIFICATION NUMBER:
RFC-PIM810710R32

5.
DESCRIPTION OF GOOD(S) 6.
HS TARIFFCLASSIFICATION
NUMBER 7.
PREFERENCE
CRITERION 8.
PRODUCER 9.
NET COST 10.
COUNTRY
OF ORIGIN
8515-90-2000 C YES NC U.S.A.
CSI Titanium Sonotrode 20kHz
qty: 1I CERTIFY THAT:

• THE INFORMATION ON THIS DOCUMENT IS TRUE AND ACCURATE AND I ASSUME THE RESPONSIBILITY FORPROVING SUCH REPRESENTATIONS. I UNDERSTAND THAT I AM LIABLE FOR ANY FALSE STATEMENTS OR MATERIAL OMISSIONS MADE ON OR IN CONNECTION WITH THIS DOCUMENT;

• I AGREE TO MAINTAIN, AND PRESENT UPONREQUEST, DOCUMENTATION NECESSARY TO SUPPORT THIS CERTIFICATE, AND TO INFORM, IN WRITING, ALL PERSONS TO WHOM THE CERTIFICATE WAS GIVEN OF ANY CHANGES THAT COULD AFFECT THE ACCURACY OR VALIDITY OF THISCERTIFICATE;

• THE GOODS ORIGINATED IN THE TERRITORY OF ANY OR MORE OF THE PARTIES, AND COMPLY WITH THE ORIGIN REQUIREMENTS SPECIFIED FOR THOSE GOODS IN THE NORTH AMERICAN FREE TRADE AGREEMENT, AND...