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Social Security Index - Antrag, Erwin Nowak

Social Security Index - Antrag, Erwin Nowak

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APPLICATION FOR SOCIAL SECUIRTY ACCOUNT NUMBER
(Or Replacement of Lost Card)
Information Furnished On This Form Is CONFIDENTIAL

550-64-5920
DO NOT WRITE IN THE ABOVE SPACE

Read Instructions on Back Before Filling In Form. Print in Dark Ink or Use Typewriter.

1. Print FULL NAME YOU USE IN WORK OR BUSINESS
(First Name) ERWIN
(Middle Name or Initial -- if none, draw line-----) JOSEF
(Last Name) NOWAK

2. Print FULL NAME GIVEN YOU AT BIRTH
ERWIN JOSEF NOWAK

3.
(Month) 10, (Day) 3, (Year) 1928

4. PLACE OF BIRTH
(City) DELMENHORST, (County) GERMANY, (State)

5. AGE ON LAST BIRTHDAY
33

6. (unlesbar)

7. xxx OR RACE
x WHITE

8. MOTHER'S FULL NAME AT HER BIRTH
ANNA BRYLLA

9. FATHER'S FULL NAME (______ living or dead)
JOSEF NOWA(K)

10. HAVE YOU EVER BEFORE APPLIED FOR OR HAD A SOCIAL SECURITY OR RAILROAD RETIREMENT NUMBER?
x NO

11. ARE YOU NOW --
x EMPLOYED

12. MAILING ADDRESS
(Number and Street)1345 DANIELSON RD, (City)SANTA BARBARA, (State)CALIFORNIA

13. TODAY'S DATE
NOV. 27th (19)61

14. Write YOUR NAME, I.E., YOU USUALLY WRITE IT (Do Not Print or Type)
(unterschrieben) Erwin J. NOWAK

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