English Translation

Model A. the office Place 32 B.No. Police permission. The Jew - The Jewess (first name, call names underline) ( surname, in the case of women also maiden name) (occupation) born on ............. in .. resident in .... (Locality) (Straße, Platz Nr.) is hereby granted (Statehood) (official photo ID) the police permission to leave his - their residential community ...... - once, repeatedly on ....... from (date) (date). This permit entitles the use of •••• (means of transport) unless a claim for this means of transport is excluded or restricted by the modes of transport or their supervisory authorities. This permit is only valid in connection with an official photo ID. Service stamp (signature) Crossing out what does not apply.