| Collection: | Odessa Duma List and Others |
| Type: | Name Change Request |
| Day: | 2 |
| Month: | 5 |
| Year: | 1909 |
| Old Calendar date1 (DD/MM/YYY): | 19/4/1909 |
| Hebrew date (DD/Month/YYYY): | 11/Iyar/5669 |
| Surname: | Khar'kovskiy |
| Given Name: | Shmul' / Mikhail |
| Age / Birth date: | |
| Sex: | M |
| Father / Patronymic of father: | Iosif / |
| Mother / Patronymic of mother: | // |
| Born Town Person / Father / Mother: | Odessa // |
| Residence2 Town Person / Father / Mother: | Odessa // |
| Occupation3 Town Person / Father / Mother: | |
| Cause of death: | |
| Marital status: | |
| Comments: | This is a change of first name in Odessa ZAGS office. The person requests to change his first name from SHMUEL to MIKHAIL |
| Spouse Surname: | |
| Spouse Given Name: | |
| Spouse Age: | |
| Spouse Father / Patronymic of father: | |
| Spouse Mother / Patronymic of mother: | |
| Born Town Spouse / Father / Mother: | |
| Residence2 Town Spouse / Father / Mother: | |
| Occupation3 Town Spouse / Father / Mother: | |
| Spouse Marital status: | |
| Spouse Comments: | |
| Witnesses: | |
| Ceremony conducted by: | |
| Circumcision conducted by / DD-MM /Old DD-MM/Hebrew Date: | |
| Archive: Name / Location / Fond / Opis / Delo /Page / Rec.No: | 39/5/131/182a |