English Translation

APPENDIX I to Provisional Order No. 7.5 INTERNATIONAL REFUGEE ORGANIZATION 8063SH0 HEADQUARTERS GENEVA Form No. CM/1 (Revised) APPLICATION FOR IRO ASSISTANCE (Please for IRO support) N.822060 .CZERNIN 5. (Family name in block capitals) (CM/1 Number) (family name in large letters) (CC/1 number) SLECHICAL 2. 6. (a) (Other spellings or aliases by which family is known) (d) By ticking an "x": Claimed Established X 3. Religion: (Check one with an "x") (claimed) (declared) Roman Catholic Protestant Coar Presumed (previously) (Roman Catholic) (probably) KRIGSDORFCSR. eek Orthodox Jewish or e) (Jewish) 6. (b) . Other (specify) (Country of last habitual residence prior to Displacement) (Last permanent residence before deportation) None Not reported UOLRSDEUTSCHE (None) 24.0.1949 (Not specified) 6. (c) (Ethnic or National group search as Ukrainian, 4. Date Of Completion of Form CM/1 Jewish People's German, etc.) (Day of completion of Form. CM/1) (People's or National Group, such as Ukrainians, Jews, People' Germans, etc) 5. Marital Status (Check one with an "x") 6 (d) Nansen Status: (Check One) Yes No A Marital status (Cross by an "X") Married Nansen Pass (cross) Yes Yes No Re Married Divorced Single Widowed Ledig Verwitwet Separated Unaccompanied child Separated Inaccompaned Child Male Relationship Date of birth Check one* Town, province, 8. Names of all members of family or to head Day, Month Country of CEF. LR and country living together Female Year Citizenship (qe sas) oace Pamen of all family members, maenl. a ee Staats-Ankreuzen Siadi, district as long as they live together core to family day, monal: belonging OO and Stadi of the eilbl. vorsland and year see above G Birth I II III IV V 6 89 10 (a) Man (man) (b) Woman (first name and maid name) Woman Name of the girl) W 3.√25C.S.R. 7 RRIGSDORF (c) Children: first name (anc ese. last name if different from ar) (d) (e) (f) (g) ) Abbrevitalons: C - claimed; E - established; F - former; LR - last habitual residence. B - claimed; A - current: F - previous; LW - last permanent residence