STÁTNÍ TAJEMNÍK U ŘÍŠSKÉHO PROTEKTORA V ČECHÁCH A NA MORAVĚ, PRAHA, inv. 2130, sig. 109-8/13 Page 203 · 203 of 355

THE SECRETARY TO THE RUSSIAN PROTECTOR IN THINGS AND IN MORAVA, PRAGUE, inv. 2130, sig. 109-8/13

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English Translation

Order form of the chief d. Seich.Pol. u. d. SD. No. 24/43 163 14 Model I (Rüekseite) the .19.. (service) Details of the person Surname (for women also birth name): Names: . Birthday: Place of birth: Occupation: .. Place of residence: Marital status: . .. Number of children (including age): .. Creed and descent: Nationality: . Membership of the NSDAP or its divisions: since. Member no. since... since official bodies in the N SDAP affiliated associations: .at (office) be attached. .at Orders and honorary signs: . Address of the next relatives: . Your notification has been made. not done because. Care measures are required and not required.