MUSTER Anlage 11b
REPUBLIK ÖSTERREICH
Land
Behörde
Nummer der Eintragung
URKUNDE
gemäß § 35 Abs. 1 PStGgemäß Paragraph 35, Absatz eins, PStG
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Vornamen
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Zeitpunkt und Ort der Totgeburt
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Geschlecht
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VATER
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Familienname
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Gemeinsamer Familienname
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Vornamen
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Wohnort
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MUTTER
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Familienname
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Gemeinsamer Familienname
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Vornamen
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Wohnort
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(Tag der Ausstellung) (Standesbeamter)
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