[Ger-Poland-Volhynia] German Gothic Handwriting

B Hirsekorn tggrtime at yahoo.ca
Tue Aug 12 11:09:30 PDT 2014

Could anyone help decipher the handwriting on a German Census form from 1900? I cannot make out the month of birth, the religion and mother language. I can read the script but not the handwriting. 

Betty Hirsekorn

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