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Me mjesto i država/Ort und Staat datum/Datum s adresom u wohnhaft in na životu. lebt. Podaci su utvrðeni na osnovi osobne iskaznice/putovnice broj Die Angaben wurden festgestellt aufgrund des Personalausweises-Passes Nr. , izdane u ausgestellt in . dana am Mjesto i datum Ort und Datum koja vrijedi do , der gültig ist bis Peèat i potpis službene osobe Stempel und Unterschrift der Amtsperson NAPOMENA: Potvrdu o životu ovjerava nadležni nositelj mirovinskog osiguranja, diplomat.

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