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7. Have you previously been a citizen of any other country?

No

( Yes or No.)

If so, list on table below the country

or countries of which you have been a citizen, the periods of your citizenship in each and the methodsby which you acquired such citizenship.

COUNTRY

PERIOD OF CITIZENSHIP

METHOD OF ACQUIRING CITIZENSHIP( check one)

From( year)

To( year)

Birth

Naturalization

Otherwise( state how)

8.( a) What is your father's full, true name?

THEODOR( First)

GROSS ZETTERITZ

( b) Where was he born? NEAR LANDSBERG ON THE WARTHE

( Middle)PRUSSIA

( Province or state)

( Town or city)

( c) When was he born?

OCT

( Month)

8( Day)

1842

( Year)

( d) Where does he now live?

DECEASED( Street and number)

( Province or state)

( Town or city)

( Country)

( Country)

( e) Of what country is he at present a citizen?

DECEASED

9.( a) What is your mother's full, true name? HENRIETTE

( First)

( Middle)

( b) Where was she born?

SOLDIN

PRUSSIA

( Town or city)

( Province or state)

( c) When was she born?... JAN

31 1846

( Month)

( Day)

( Year)

( d) Where does she now live?

DECEASED

( Street and number)

( Province or state)

GOHLKE( Last)

GERMANY

( Country)

GOHLKE

( Last)

GERMANY

( Country)

( Town or city)

( Country)

( e) Of what country is she at present a citizen?

DECEASED

( Country)

10. In what places have you resided for more than 1 year at a time since the time of your birth?

CITY OR TOWN

PROVINCE OR STATE

COUNTRY

Month

FROM-

Year

Month

To-

Year

LANDSBERG PRUSSIA

BERLIN PRUSSIA

GERMANY MARCH 1879GERMANY

1906

1906

MARCH 1913

COLOGNE PRUSSIA GERMANY MARCH 1913 MARCH 1917

BERLIN

MAY

1933

PRUSSIA GERMANY MARCH 1917( If needed, use blank sheet at the end of form and mark your answer" Question 10") CONTINUED PAGE21

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