English Translation

Annex 19 to K 16 — 100 — 70, pp. 19. 3-128 Personal data sheet File overview= and criminal record 1. a) Surname, including surnames (for women also a) Birth name, if applicable name of the previous marriage man) b) b. First names (call name to be underlined) 2. (a) Occupation a) However, the professional relationship must be indicated whether the holder, master craftsman, business manager or assistant, journeyman, apprentice, factory worker, assistant, seller, etc. (b) Income ratios b) c) Yes, since c) Unemployed? no 3. Born in the district of Landgerichtsbezirk Land 4. Apartment or last stay in administrative district Land Straße No. 2ct telex *) Strike out what does not apply.