Date and place of birth: 12 November 1891, Midwolda Gr.
Partner: Asser Jacobs
Original address: Emmakade N.Z. 39, Leeuwarden
Hiding address: Oosteinde 16, Balk
District of the LO: Sneek
Brought to reception address by: G. v. Wiersma
Brought to hiding address by: de Vries
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