English Translation

22 See S taat spo l i ze i Staetapolizei-leit-stelle .....,den............194. Tgb.Nr. To the Reichsicherbeitshauptamt R efe ra t IVB 4 in B e r l i n. Subject: Property default in Jews due to the ll.Verordnung zum Reiehsbürgergesett von........... (RGBl.I S...........). Reference: Attachments: I ask to make the statement that the property of the Jews (the Jews) who had the last German nationality is forfeited to the Reich on the basis of d:r 11. Ordnung zum Reichsbürgergesetz of ............. (RGBl.I, p..........). 1.) Last name: First name: (in the case of Preuen also birth name) (emphasis on callnames) 2.) Birthday: 3.) Place of birth and circle: 4.) Last domestic, place of residence: (specify address) 5.) Date of departure: (if it is before the entry into force of the 11th Ordinance on R3G, that is sufficient) 6.) Inlindisobe assets: (type of assets and their approximate value must be given, further indication whether the assets have already been secured) 7.) Whether pensions, pension charges, etc. and the cessation of the decomposition is caused by: