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The application must be in duplicate and accompanied by three unmounted photographs of the applicant, not larger than three
N
e
by application and its duplicate, respectively. The photographs must be on thin paper and should have a light background. The
thrée inches in size, one of which is to be affixed to the passport by the Department; the other two must be attached to this
one attached to the application should be signed by the applicant across its face, so as not to obscure the features.
et
m
This Flank must be completely
filled out. The legal fee of one dollar,
[EDITION OF 1917.]
in currency or postal money order,
No.
must accompany the application.
A woman's application must state
[FORM FOR NATIVE CITIZEN.]
whether she is married or not, and a
married woman must state whether
Issued
her husband is a native citizen.
The rules should be carefully read
before mailing the application to the
Department of State, Bureau of Citi-
zenship, Washington, D. C.
UNITED STATES OF AMERICA.
think
STATE OF Pennsylvania
23709
ss:
COUNTY OF Allegheny
Matilda Conn, a subject of Great Britain, a NATIVE AND haying LOYAL CITIZEN declared OF THE her
M
I,
intention to become
UNITED STATEG, hereby appry to the Department of State, at Washington, for a passport.
can
ati
I solemnly swear that I was born at Londonderry, Ireland
,
on or about the 16th day of March
, 1 890 * that
father
my
William Conn
was born in Ireland
,
and is now residing at
( dead )
to the Kxited States
on or about
1,1
; that he resided
years, uninterruptedly, in
the United States, from 1
to 1
, at
; that he was
Court
M
naturalized as a citizen of the United States before the
of
, at
,
on
1
, as shown by the accompanying Certificate of Naturalization];
that I have resided outside the United States at the following places for the following periods:
, from
to
, from
to
and that I am domiciled in the United States, my permanent residence being at Pittsburgh
a
in the State of
Penn'a
, where I follow the occupation of graduate nurse
My last passport was obtained from
on
and was
I em about to go abroad temporarily; and I
(Diposition of passport.)
Pmonons
intend to return to the United States within one
1
years
} with the purpose of residing and per-
forming the duties of citizenship therein; and I desire a passport for use in isiting the countries here-
inafter named for the following purpose:
England
Amer. Red Cross work
(Name of country.)
(Opject of visit.)
#
"
"
"
France
(Name of country.)
(Object of visit.)
(Name of country.)
(Object of visit.)
I intend to leave the United Statos from the port of
New York
(Port of departure.)
possibly the early part of October 191 8.
sailing on board the
on
(Name of vessel.)
(Date of departure.)
OATH OF ALLEGIANCE.
Further, I do solemnly swear that I will support and defend the Constitution of the United States
against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and
that I take this obligation freely, without any mental reservation or purpose of evasion: So help me God.
matilda bonn
(Signature of applicant.)
Sworn to before me this 23rd
day
of
Sept.
19.18
[SEAL OP COURT.]
Bheamble
Deputy Clerk of the District
Court at Pittsbungh, Pa.
* A person born in the United States should submit a birth certificate with his application, or if the birth was
not officially recorded, affidavits from the attending physician, parents, or other persons having actual knowledge
of the birth.
t If the applicant's father was born in this country, lines should be drawn through the blanks in brackets.
[OVER.]
1.-84
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- photo
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Document data
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- 2661453
- Core
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- Type
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DTO data
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Context sent to Scholar
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"ocrText": "F\nThe application must be in duplicate and accompanied by three unmounted photographs of the applicant, not larger than three\nN\ne\nby application and its duplicate, respectively. The photographs must be on thin paper and should have a light background. The\nthrée inches in size, one of which is to be affixed to the passport by the Department; the other two must be attached to this\none attached to the application should be signed by the applicant across its face, so as not to obscure the features.\net\nm\nThis Flank must be completely\nfilled out. The legal fee of one dollar,\n[EDITION OF 1917.]\nin currency or postal money order,\nNo.\nmust accompany the application.\nA woman's application must state\n[FORM FOR NATIVE CITIZEN.]\nwhether she is married or not, and a\nmarried woman must state whether\nIssued\nher husband is a native citizen.\nThe rules should be carefully read\nbefore mailing the application to the\nDepartment of State, Bureau of Citi-\nzenship, Washington, D. C.\nUNITED STATES OF AMERICA.\nthink\nSTATE OF Pennsylvania\n23709\nss:\nCOUNTY OF Allegheny\nMatilda Conn, a subject of Great Britain, a NATIVE AND haying LOYAL CITIZEN declared OF THE her\nM\nI,\nintention to become\nUNITED STATEG, hereby appry to the Department of State, at Washington, for a passport.\ncan\nati\nI solemnly swear that I was born at Londonderry, Ireland\n,\non or about the 16th day of March\n, 1 890 * that\nfather\nmy\nWilliam Conn\nwas born in Ireland\n,\nand is now residing at\n( dead )\nto the Kxited States\non or about\n1,1\n; that he resided\nyears, uninterruptedly, in\nthe United States, from 1\nto 1\n, at\n; that he was\nCourt\nM\nnaturalized as a citizen of the United States before the\nof\n, at\n,\non\n1\n, as shown by the accompanying Certificate of Naturalization];\nthat I have resided outside the United States at the following places for the following periods:\n, from\nto\n, from\nto\nand that I am domiciled in the United States, my permanent residence being at Pittsburgh\na\nin the State of\nPenn'a\n, where I follow the occupation of graduate nurse\nMy last passport was obtained from\non\nand was\nI em about to go abroad temporarily; and I\n(Diposition of passport.)\nPmonons\nintend to return to the United States within one\n1\nyears\n} with the purpose of residing and per-\nforming the duties of citizenship therein; and I desire a passport for use in isiting the countries here-\ninafter named for the following purpose:\nEngland\nAmer. Red Cross work\n(Name of country.)\n(Opject of visit.)\n#\n\"\n\"\n\"\nFrance\n(Name of country.)\n(Object of visit.)\n(Name of country.)\n(Object of visit.)\nI intend to leave the United Statos from the port of\nNew York\n(Port of departure.)\npossibly the early part of October 191 8.\nsailing on board the\non\n(Name of vessel.)\n(Date of departure.)\nOATH OF ALLEGIANCE.\nFurther, I do solemnly swear that I will support and defend the Constitution of the United States\nagainst all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and\nthat I take this obligation freely, without any mental reservation or purpose of evasion: So help me God.\nmatilda bonn\n(Signature of applicant.)\nSworn to before me this 23rd\nday\nof\nSept.\n19.18\n[SEAL OP COURT.]\nBheamble\nDeputy Clerk of the District\nCourt at Pittsbungh, Pa.\n* A person born in the United States should submit a birth certificate with his application, or if the birth was\nnot officially recorded, affidavits from the attending physician, parents, or other persons having actual knowledge\nof the birth.\nt If the applicant's father was born in this country, lines should be drawn through the blanks in brackets.\n[OVER.]\n1.-84"
}