English Translation

07 Which guarantors can you give for your commitment to the German people? 8. Number of children:exfov 1. First name...........Rel.Concession .Mother's language. 2. 11 T 11 3. " 11 4: 11 ' 11 "1 5: 11 " ..... 71 6. 11 " 1 7. 11 il 1 9. Which schools did your children attend before 1.9.39? a) German (exact name of the school genus)....... b) Polish (exaccurate name of school genus)... 10. I have always known myself about the German people, also before the 1.9.1939. I know that in the case of false information except for the German community. If this declaration cannot be made, all reasons for this must be stated. 11. I assure affidavit that I have answered the above questions truthfully. I know that in case of deliberately false information I am punishable..........19... BOb meb (self-handed signature) Free for examination note: aeb sr sXousus de 91297 LINA LotteV cenoleW BOUEOy