| Order # [ # Zamowienia] : | ||
| Date of Order [Data Zamowienia]: | ||
| To [Do]: | Archive Name: | |
| Address [Adres]: | ||
| Address [Adres]: | ||
| Postal Code + Town | ||
| Country: | ||
| Email: | ||
| Ordered by [Zamowione]: | Name [Nazwisko]: | |
| Address [Adres]: | ||
| Address [Adres]: | ||
| Town [Miasto]: | ||
| State/Province: | ||
| Postal Code: | ||
| Country: | ||
| Email: | ||
| Source of Information [Zorodlo Informacji]: | Jewish Records Indexing - Poland database | |
Please accept my order for photocopies of the following records:
[Prosze przyjac moje zamowienie na fotokopie nastepujacych dokumentow]:
| Town | Fond # | District or Signature | Year | Type | Akt | SURNAME | Given Name(s) |
|---|---|---|---|---|---|---|---|
| [Miasto] | [Nr Zbioru] | [Cyrkuli / Sygnatura] | [Rok] | [Typ] | [Aktu] | [NAZWISKO] | [Imie / Imiona] |
I hereby declare that the copies of archival records in this Order will be used exclusively for my own family history research.
[Ninijeszym oswiadczam iz kopie metrk wyszczegolnione w moim zamowieniu beda wykorzystane wylacznie do prac nad historia mojej rodziny.]