Signature is illegible. On the back of the form is a duplicate of an unknown invoice. Graphite pencil on paper, manuscript.
Extent: 1 sheet.
Size and dimensions of original material: 10,5 х 17,4.
Condition of original material: on the lower edge there are two holes from the hole punch, the corners are wrinkled, numerous small gaps along the edges. The left edge is uneven. A trace from a fold in half.
Former external reference: КМЗ ВХ-34/20/57.