English Translation

J-10/2 SIS 148 Category II. Form. 2 (All forms must be submitted in five copies.) Place of Type of Christian Date and place Sex Usual place Name Present employment employment name of birth of residence address during the war Name Birth date Dec. during the war 1 2 3 4 5 6 e rebco Z Nationality Czechoslovakia- Dubb Paul 29.10.06 m Tuzina Donaustr.88 Mnch. Zimmerer, Tuzine Capkowa Olga 6.1.27 M Prague observatorium "21," student, Prague Czernin Alix 20.5.09 M Munich Copernicusstr.1," without Munich Dejnicyn Jwan 5.1.91 m Kharkov Kolbergerst.29," art no. 23.8.18 M Kiev 14 " Wife Kiev Deinisin Michael 20.10.21 UI Bbilis Montgelasstr.5, Mnch.Mach.Bbilis Evaschitzky Lydia 20.5.20 M Wien Normannenp1 17,Mnch. Secret. Wien Hordossy Fdd 6.8.20 M Preßburg Barbarossastr.ll, Schneid. Bratislava Jeremic Nancy 7.8.23 m Casak Trogerstr.2, Mnch, without Cadak Kohout Premsýl 23.10.01 m Jnstanbul Jnnstr.3, Mnch kaufm.Ang. Jnstanbul Children under 15 Name and relationship Children currently under 15 years of age guardian resp. where living Name and relatives grad des ges. represensants, eventl. bei wem besichtlich (Date/Date) (Signature/Stamp) 10. Polizeirevter 12 August 1916 10.PolizeiRevier München, den (Stempel) (signature of the authority) Wrolernbrubs