ùàìåï        Fragebogen

 

______________________                __________________             ____________________

            Nachname                                         Vorname                           Geborene...

 

____________________                    ______________________ 

        Geburtsdatum                                       Geburtsort 

 

_____________________________________________---

                                       Wohnhaft   

 

___________________________________          ___________________________________

                       Beruf                                                         Spezielles, wie E. K. I.

 

_________________________________               ___________________________________

                                                     Aktiv in der Gemeinde

 

____________________________________________              _____________________

                           Umgekommen in                                                             Datum

 

______________________            ________________________ áï_____________________

                              úàøéê îååú òáøé                                                 äùí äòáøé

 

 

ðîñø òì éãé___________________________            ëúåáú__________________________________

 

èìôåï_________________________          ô÷ñ_________________________---

 

 

 

ðà ìùìåç ãîé äùúúôåú áäåöàåú áñê 100 ù"ç ìàéâåã éåöàé ÷äéìåú îøëæ àéøåôä (ò"ø)

çùáåï áð÷ äãåàø   8206422.

 

 

 

çáøé äååòãä: îø ùìîä îàéø, ôøåô' ãï îéëîï, âá' äéìãä äåôîï, îø àåøé ÷ìøîï, ôøåô' îàéø ùåøõ, éå"ø.