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["Freiwillige Selbstauskunft","Torsten Hirtz  Schulstr.139 , 47199 Duisburg","hirtz-immobilien@t-online.de"]
[null,"Tel.02841/3677784 ,  Fax  02841/3677783","www.hirtz-immobilien.de"]
["Gewerbe"]
["Persönliche Angaben"]
[null,"Mieter","weitere Mieter"]
["Name,Vorname"]
["Adresse"]
["Geburtsdatum"]
["Telefon /  Handy"]
["Beruf"]
["Branche"]
["monatliches Nettoeinkommen"]
["Abgabe einer eidesstattlichen Versicherung ?","                      ja                                 nein","                      ja                                 nein"]
["vorliegende Pfändungen ?   Schufaeintrag ?","                      ja                                 nein","                      ja                                 nein"]
["Sonstiges "]
[]
["Ich versichere , daß ich obige Angaben wahrheitsgemäß gemacht habe."]
["Wichtig !  Abschluss Mietvertrag nur mit Vorlage Personalausweis+Zahlung Kaution"]
[]
["Ort ","Datum","Unterschrift"]
[]
[]
["___________________","_______________________","______________________________"]

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