Paper, ink, manuscript. Written on a single sheet o paper in green ink. Board member's signature is illegible. To the left along the edge of the sheet, perpendicular to the main text, is the text of the assurance of the signature of the village council member and a round blue seal: “Shunga Village Council of Shunga volost Kostroma Gubispolkom” with the coat of arms of the RSFSR. It contains information on the family and the level of material well-being.
Extent: 1 sheet.
Size and dimensions of original material: 11,3 х 15,7.
Condition of original material: on the lower edge are two holes from the hole punch; numerous small gaps along the edges. A sheet was folded 8 times. Spotted on the back.
Former external reference: КМЗ ВХ-34/20/7.
