English Translation

APPLICATION BY AN ALIEN FOR A CERTIFICATE
OF NATURALISATION

The instructions accompanying this form must be read carefully before the form is completed.
Portions of the form which are not applicable should be struck out and initialled in every case.

1. Original name in full
/Count/ Joseph Vincent Adalbertus Maria
Romanus Czernin
Joseph Czernin

2. Present address
23, Seymour Place, London, W.1.

3. Father
(in BLOCK LETTERS)
Francis Joseph Czernin
Present address (if living)
23, Seymour Pl., London, W.1.
Nationality (if dead, at time of death)

Mother's full name before marriage in country of her birth
(in BLOCK LETTERS)
Vilemina Czernin
Present address (if living)
23, Seymour Pl., London, W.1.
Nationality (if dead, at time of death)

NOTICE IS HEREBY GIVEN that JOSEPH CZERNIN, of 23, Seymour Place, London, W.1, is applying to the Home Secretary for naturalization, and that any person who knows any reason why naturalization should not be granted should send a written and signed statement of the facts to the Under-Secretary of State, Home Office (Nationality Division), Princeton House, 271, High Holborn, W.C.1. (MMB).

NOTICE IS HEREBY GIVEN that JOSEPH CZERNIN, of 23, Seymour Place, London, W.1, is applying to the Home Secretary for naturalization, and that any person who knows any reason why naturalization should not be granted should send a written and signed statement of the facts to the Under-Secretary of State, Home Office (Nationality Division), Princeton House, 271, High Holborn, W.C.1. (MMB).

PUBLISHED BY HER MAJESTY'S STATIONERY OFFICE
To be purchased from
York House, Kingsway, LONDON, W.C.2
423 Oxford Street, LONDON, W.1
P.O. Box, 569, LONDON, S.E.1
3a Castle Street, EDINBURGH 2