English Translation

I 5h55 ITS 004 5. Poljetcester ITS 004 Category III. (All forms are in finffacher Gemeinde.....Munich Form. 7 Submit a copy) Pension Stella Mändhen 23 Landkreis München Exhibiting authority Stadt- Kaulbachskrake 91 - Tal. 312M List of all all allied Nationals and all other owners, German Jews and stateless ete. who were temporarily or permanenily stationed in the community, but are no longer in residence. Munich has resided, list of names of all military and civilians of the United Nations, other foreigners, German Jews and stateless persons who are temporarily or permanently in the congregation but are now no longer resident there. Nationality Bohemia dYR Lal A55 (For each nationality a special form is to be used.) anoger. Place of burial Personal effects left Date and Place Usual place Type of Unit Date of sojourn Date of Death Cause of Death Identity Number Namo d Sex and grave No. to of residence yes no Number of the grave no. Property Family Name First Name Birth Date Gender Home Town Type of Unit Residence Data mo Cause of Death Detection Mark Place indication d. Grabes e! no and place m. M 10 i1 12 1 2 3 4 5 6 7 8 9 Maris 20.9.06 no + Grüfin Bzernin weibl. unknown 23.1.40 (Czernin Dymokury up to 16.2.40 W The documents considered as custodians : Kartiblatler-Files-Foreign Book (selection time here entered residence time) are kept at the place of completion indicated above. They do not contain any further information for forms 9 - 11 in addition to those taken over here. Marie Haeiusler Pension Stella München 23 (Signature/Stamp) (Date/Date) Marie Haeusler Katalbachsiralye 91 - Tal. 31284 Munchen, dn... Pebruar..1948. (Stamps) (Signatory of the Aust. Behürdo) J.G. Weiff'sche Buchdruckerei und Verlag. München.