English Translation

12 Appendix a German People's List 3= B333=3== Branch......................................... Additional questionnaire for the determination of German ethnicity No.... 1. Confession: godly, evangelical, catholic......... Confession of the spouse: Godly, Protestant, Catholic............................ 2. Where employed:........... Activity before 1.9.1939:..3. Surname, first name and origin of the parents, grandparents: B ..born.. in: Mother:.... Grandfather (father's):...... Grandmother " Grandpa (mother's):... Grandfather " 4. To point 12 of the above questionnaire: Which schools did you visit: a) German........... from...... to b) Polish......... 5. Concerning point 9 of the above questionnaire: indication of nationality or mother tongue in the Polish military passport: ....... 6. Concerning item 10 of the questionnaire: Which associations listed there etc. did you belong to before 1.9.1939? from. to 11 7. Regarding point 12 of the above questionnaire: What persecutions (prison and fines, economic charges, deportations, etc.) were you subjected to on the basis of your commitment to the German people?....