PA NAFTA form

North American Free Trade Agreement Certificate of Origin
1. EXPORTER NAME AND ADDRESS Pennsylvania Machine Works, Inc. 201 Bethel Avenue Aston, Pa 19014-3443 U.S.A. TAX IDENTIFICATION NUMBER: 231988630		2. BLANKET PERIOD (DD/MM/YR) FROM: 01/01/2011 TO: 31/12/2011
3. PRODUCER NAME AND ADDRESS: SAME AS ABOVE TAX IDENTIFICATION NUMBER:		4. IMPORTER NAME AND ADDRESS: TAX IDENTIFICATION NUMBER:
5. DESCRIPTION OF GOOD(S):	6. H.S. TARIFF CLASSIFICATION NUMBER	7. PREFERENCE CRITERION	8. PRODUCER	9. NET COST	10. COUNTRY OF ORIGIN
Stainless Steel Pipe Fittings	7307.23	C	YES	NO	U.S.
Stainless Steel Pipe Nipples	7307.29	C	YES	NO	U.S.
Carbon Steel Pipe Fittings	7307.93	C	YES	NO	U.S.
Carbon Steel Pipe Nipples	7307.99	C	YES	NO	U.S.
Chrome-Moly Pipe Fittings	7307.93	C	YES	NO	U.S.
Aluminum Pipe Fittings	7609.00	C	YES	NO	U.S.
Ni/Cu 400 Pipe Fittings	7507.20	C	YES	NO	U.S.
Ni 200 Pipe Fittings	7507.20	C	YES	NO	U.S.
Low Temperature Pipe Fittings	7307.99	C	YES	NO	U.S.
Forged Steel Pipe Fittings	7307.92	C	YES	NO	U.S.
Other Stainless Steel Fittings	7307.29	C	YES	NO	U.S.
Other Fittings - Other Than Stainless Steel	7307.99	C	YES	NO	U.S.
I CERTIFY THAT: -The Information on this document is true and accurate and I assume the responsibility for proving 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 upon request, 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 this certificate; -The goods originated in the territory of one or more of the Parties, and comply with the origin requirements specified for those goods in the North American Free Trade Agreement, and unless specifically exempted in Article 411 or Annex 401, there has been no further production or any other operation outside the territories of the parties; and -This certificate consists of 1 page(s), including all attachments.
11. AUTHORIZED SIGNATURE:		COMPANY: PENNSYLVANIA MACHINE WORKS
		DATE: 12/31/2010
		TELEPHONE: 610-497-3300 FAX: 610-497-3325
NAME: James B. Friant		TITLE: Manager

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