English Translation

1.) Single apartment house Prague ..No (district), (street) 2.) Name of the apartment in the house: ......... Zinmerwohnung .......... Floor No ........- left - right ~ center - 3.) Name and surname of the tenant: ............. Grade o 0° 4.) Family member - the security police as official - Anutellten - or SD . 5.) Number of roommates .......... (sub-letters): ......... (name - occupation) 6.) number of rooms rented: ....... rooms, kitchen, bathroom, other side rooms: ..... .- garage - use of the garden etc. ................ 7.) a refrigerator is provided for sale? .....since ........ size and brand ......... 8.) lease agreement - in writing - at least - concluded on . 10.) Agreed rental interest monthly .. . . . RM agreed ancillary fees .. ... . Rm flat rate heating and hot water contributions: yes - no Comnt tenants themselves for heating on ? 11. Special agreements: ...... 12.) Existing rental interest arrears and for what time ? . .. RM 13.) Comments: Signature: Prague, on ....