01-18-2016, 11:30 PM
[SIZE="3"]Form nr. 1
(To be filled out clearly, without any corrections)
Record card
Date and place of issue of the order or medal (raion, city, oblast, krai, republic):
September 22nd, 1986; Military Commissariat of the Vasilyevsky Island Raion, city of Leningrad
1. Last name: Lis
2. First name and patronymic: Vasily Semyonovich
3. Nationality: Russian
4. Sex: Male
5. Year of birth: 1966
6. Place of birth: City of Kirovsk, Murmansk Oblast
7. Party membership (since which year): Member of the Komsomol
8. Education: Secondary special education
9. Military rank (for service members): Private
10. Since which year in the Soviet Army (for service members): Since 1984
11. Place of employment or service and position occupied at the time of the award: Scout-machine gunner in military unit nr. 51863
12. Current place of employment or service and position: Lathe operator at Workshop nr. 22, Kulakov Factory, city of Leningrad
13. Home address of the awardee (raion, city, oblast, krai, republic): 80 13th Linia Street, room 56, city of Leningrad
14. List of all awards received (in chronological order):
Name of the order or medal*/Serial number/Number of the order booklet or medal certificate/Ground of issue (awarded when and by whom)
Order of the Red Star/3766134/Order booklet nr. L-533182/Decree of the Presidium of the Supreme Soviet of May 26, 1986
Signature of the awardee: [signed]
I confirm the correctness of the data and the signature of the awardee (position and signature):
Military commissar of the Vasilyevsky Island Raion, city of Leningrad
Captain 1st Grade [signed] /Khvost____/
September 22nd, 1986
* Only list orders of the USSR and the following medals: Gold Star Medal of a Hero of the Soviet Union, Gold Hammer and Sickle Medal of a Hero of Socialist Labor, Medal for Courage, Medal of Ushakov, Medal for Combat Merit, Medal of Nakhimov, Medal for Labor Valor, Medal for Labor Distinction, and Medal for a Partisan of the Patriotic War.
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(To be filled out clearly, without any corrections)
Record card
Date and place of issue of the order or medal (raion, city, oblast, krai, republic):
September 22nd, 1986; Military Commissariat of the Vasilyevsky Island Raion, city of Leningrad
1. Last name: Lis
2. First name and patronymic: Vasily Semyonovich
3. Nationality: Russian
4. Sex: Male
5. Year of birth: 1966
6. Place of birth: City of Kirovsk, Murmansk Oblast
7. Party membership (since which year): Member of the Komsomol
8. Education: Secondary special education
9. Military rank (for service members): Private
10. Since which year in the Soviet Army (for service members): Since 1984
11. Place of employment or service and position occupied at the time of the award: Scout-machine gunner in military unit nr. 51863
12. Current place of employment or service and position: Lathe operator at Workshop nr. 22, Kulakov Factory, city of Leningrad
13. Home address of the awardee (raion, city, oblast, krai, republic): 80 13th Linia Street, room 56, city of Leningrad
14. List of all awards received (in chronological order):
Name of the order or medal*/Serial number/Number of the order booklet or medal certificate/Ground of issue (awarded when and by whom)
Order of the Red Star/3766134/Order booklet nr. L-533182/Decree of the Presidium of the Supreme Soviet of May 26, 1986
Signature of the awardee: [signed]
I confirm the correctness of the data and the signature of the awardee (position and signature):
Military commissar of the Vasilyevsky Island Raion, city of Leningrad
Captain 1st Grade [signed] /Khvost____/
September 22nd, 1986
* Only list orders of the USSR and the following medals: Gold Star Medal of a Hero of the Soviet Union, Gold Hammer and Sickle Medal of a Hero of Socialist Labor, Medal for Courage, Medal of Ushakov, Medal for Combat Merit, Medal of Nakhimov, Medal for Labor Valor, Medal for Labor Distinction, and Medal for a Partisan of the Patriotic War.
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