Date and place of birth: 4 February 1904, Surhuisterveen
Original address: Weg Rottevalle 159A, Houtigehage
Occupation/profession: Metselaar, Gem. Sm.
Identity card: gewijzigd
Ground for hiding out: krijgsgevangene
Hiding address: G v Wijk winkelier, Oudeschoot
District of the LO: Drachten
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