English Translation

3 635 prison — penitentiary in 111 application for Zahnersaz t G Seisspreft zemiis 470742 For the purposes of going, I apply as an institutional dentist Zahnersaz to the following extent: Fee according to contract from the upper jaw base plate . . RM teeth . . - "1 brackets ww 11 suction cups . . . 11 mandible base plate. . . RM teeth. 11 parentheses 11 total RM (the extent of the prosthesis shall be indicated by means of a continuous line). V or start of the treatment of the dentures shall be extracted from the following teeth (roots): Justification: afo Hmpreert Cerein Place and date: The applicant dentist: 24.NOV. 1943 fr bous Rahe Statement of the institution physician : The above requested dental food is - not subject to their valid fixation of the mountain huts according to §§ 6, 7, 8, 9 of the yield of the approved. This communication is to be attached to the fee analysis after completion of the treatment. M (Advisory) K. G. - Tg. — No 84. Request for dental examination.