Yad Vashem Documents

YAD VASHEM
Martyrs' and Heroes'
Remembrance Authority
P.O.B. 3477 Jerusalem, Israel


Tu-'-1
A Pag o Tnllon
A Page of Testimony


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THE MARTYRS' AND HEROES'
REMEMBRANCE LAW, 5713-1953 1953 vn ,D1-tV 711) 'N OWpmN 1J jp)N 1,Vt) ONT
determines in article No. 2 that :2 u 33 N7IN7NND N cDYO O 5Vw
The task of YAD VASHEM is to gather into oYT 7 T3Ntn pN I Nx N 1 N m o)-T ) po Vy3Na)iN 1T
the homeland material regarding all those WO) "n IrI Nn ,- t w w ry) Y VNI ,17 vN 0po p)T3)N
members of the Jewish people who laid down
their lives, who fought and rebelled against the PN Nm'W Iy'SNM o)Y t W V YW~yy)p IN 7 p N o~ypy ,) 'nV
Nazi enemy and his collaborators, and to OY'~NP3NnN 'f ,ninp j'n ,y'I 11N t pIN ,1D7ynt1V)N t ,
perpetuate their NAMES and those of the Y,, 2,1% pN'13 ) 3r'M n IYY y-yn ,0yIN),o oVN pN
communities, organizations, and institutions .xN 15' N ppYVm P )W) l D' V,'1r loN
which were destroyed because they were 1 p W o pnn
Jewish. (82.8.3591 ,,IvIn 5'5N v) ,231 'DW) 13-y Yt))
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DETAILS OF VICTIM: INSCRIBE EACH VICTIM ON A SEPARATE PAGE, IN BLOCK LETTERS
Family name: 'T / -r F :)v -0,>,0N0 .1

First name: T V'"" :1r3N )1N9 .2

Previous name: S TIi/ T7 0 O) vT7 7N i)N)-Y)):DNs .3
(nee for woman) :(,fL N 1N~) lnf
/ "J un mN 0.6 11 p. 05N )())N YN) YN-tVITY) .4
/ Fam. status Sex Birth date or appr. age
Birth place pQ(v) 47 t)1 TN .7
and country:" T L-:('4 AN ,N1VY.)
IL First name: S 7/,A : WmN)in ODY )I- 17)tDI 3.8
mother Maiden name/nee: 7 1) A / / : N- 3 D03 lpy3 N
Victim's First name: C y .7/l /// :1 N oy7 pUND .9
father 2 ,_- o" y'3V~rp^D
Victim's First name: :1-N)1N p o .10
spouse Maiden name/nee: N tI y E T RI E j:T' :,,N0-YW1T. D )) 30y 3pY)N D01
Permanent residence /J U.) N U- r NN) f-{N ,iyNU~D- .11
place and country: .( :( ,V)N5 O)
Wartime residence K( OLtJ. / /C (,, /( T-1 -rf n n1Yt f:3 7T901Y V .12
place and country: / 0/ :(T3N( 7.w)
Date/year CC/ CT. / i .14 Victim's 0 (JO3 .13
of death: :onU profession: TVC.?f :fN W1tN
Death place: q T F! foV &- ( /&T ) .... N 1N .15
Circumstances oT death: 1p p 5. L f //,_... p.


Reported by:
I, the undersigned 77 V// V 7A-/PT


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Residing at (address) I-I- t ( A( ,7 ,m ,/ / A fRv rsN) wi VN))


Relationship to victim (family/other) f


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HEREBY DECLARE THAT THIS TESTIMONY IS CORRECT TO THE BEST O MY KNOW EDG
Place and date '/ / NT N 71N Signature jl0IN


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