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Front: Tan form with printed information in a list on the lefthand side and information written in pencil in printed boxes on the righthand side. A blue oval stamp with Star of David on lefthand side, and a red checkmark in the middle.
Back: Printed infromation in a list on the lefthand side (bullet points 9-12) and information written in pencil in printed boxes in the righthand side. Includes a purple stamp with date in middle. These pre-printed forms were used for determining an individual's work in the Lwow Ghetto.
Information Provided by Michael D. Bulmash:
Pre-printed form, double-sided, used for determining individual's work, each with blue LWOW Ghetto marking.
5 3/4 x 8 1/4"
Star of David, Stamp, WLOW, Ghetto
"Form Issued to Prisoner 5494 in Lwow Ghetto" (1943). Bulmash Family Holocaust Collection. 2015.2.51.