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Certified transcript from the birth register of the Standesamt Seeben, formerly Gr. Koschlau
No. 105
Wansen, 25 December 1876
Before the undersigned civil registrar appeared today, personally known, the innkeeper Friedrich Kollwitz, residing in Wansen village, Protestant religion, and declared that his wife Amalie Kollwitz nee Dulega, residing with him in Wansen village, gave birth in his presence, on 19 December 1876 in the afternoon at 10 o'clock, to a male child. and that the child received the names Adam Adolf.
Read, approved, and signed,
[signature xxx] Friedrich Kollwitz
The Civil Registrar
[signature] Melin
The concordance with the entry in the birth register is hereby certified.
Seeben, 22 January 1942
The Civil Registrar
[signature] [Sczepanski?]
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