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I have used another name in this country than that given at the beginning of this form. If so, it was I used that name because The full name of the person shown on my steamship ticket was My mother's maiden name was My name was (if woman) maiden Marie Augusting burgent My post-office address is 15 Smith at The on came country was ticket which I to this bought at St Kiths B.W.J. (City) (Country) arrival by ship: Name of steamship line was quebee Line 1st cabin If 2d cabin 2nd 3d cabin I arrived as (passenger, stowaway, seaman, member of crew, or otherwise) passenger (State which) I traveled on (an immigration visa, a passport, a permit) new London N.L Come (State which) I paid #2 head tax at , on 1927 (State amount) (City) (State or country) (Month) (Day) (Year) I was examined by immigration officers at Ellis's Island new york At that time I intended to remain (permanently, temporarily, for visit, in transit) (State which) The person in the I coming to was augustine (Give Gumby in full) permanetty United States was The place in the United States I was going to was 46 Goshen at name new London The names of some of the persons or passengers I traveled with were - ADDITIONAL FACTS TO BE GIVEN IF ALIEN CAME FROM OR THROUGH CANADA OR MEXICO: (a) The place in Canada where I landed was , on (Month) (Day) (Year) { Canada (b) The place in from which I entered the United States was Mexico (c) On (Month) (Day) (Year) (d) The place where I was examined for admission at the United States border was (e) If not examined, state why, and give the circumstances of your entry Canada (f) The place in Mexico where I bought my railroad ticket to come to the United States was GOVERNOMENT PRENTING officm 14- (OVER) (Signature of applicant)

Page data

Page
1062
Source index
0
Type
photo
Media ID
988218e7aebd65ec
Size
unknown

Document data

ID
159596813
Core
doc
Type
document
DTO data
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Context sent to Scholar

Document identity
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Document source metadata
{
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    "sourceUrl": "https://catalog.archives.gov/id/159596813",
    "contentType": "document",
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Document source extras
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Page context
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    "ocrText": "I have\nused another name in this country than that given at the beginning of this form. If so, it was\nI used that name because\nThe full name of the person shown on my steamship ticket was\nMy mother's maiden name was\nMy name was (if woman)\nmaiden Marie\nAugusting burgent\nMy post-office address is\n15 Smith at\nThe on came country was\nticket which I to this bought at St Kiths\nB.W.J.\n(City)\n(Country)\narrival by ship: Name of steamship line was quebee Line\n1st cabin\nIf\n2d cabin\n2nd\n3d cabin\nI arrived as (passenger, stowaway, seaman, member of crew, or otherwise)\npassenger\n(State which)\nI traveled on (an immigration visa, a passport, a permit)\nnew London N.L Come\n(State which)\nI paid #2\nhead tax at\n, on\n1927\n(State amount)\n(City)\n(State or country)\n(Month)\n(Day)\n(Year)\nI was examined by immigration officers at\nEllis's Island new york\nAt that\ntime I intended to remain (permanently, temporarily, for visit, in transit) (State which)\nThe\nperson\nin\nthe\nI\ncoming to was augustine (Give Gumby in full)\npermanetty\nUnited\nStates\nwas\nThe place in the United States I was going to was 46 Goshen at name new London\nThe names of some of the persons or passengers I traveled with were\n-\nADDITIONAL FACTS TO BE GIVEN IF ALIEN CAME FROM OR THROUGH CANADA OR MEXICO:\n(a) The place in Canada where I landed was\n, on\n(Month)\n(Day)\n(Year)\n{\nCanada\n(b) The place in\nfrom which I entered the United States was\nMexico\n(c) On\n(Month)\n(Day)\n(Year)\n(d) The place where I was examined for admission at the United States border was\n(e) If not examined, state why, and give the circumstances of your entry\nCanada\n(f) The place in\nMexico\nwhere I bought my railroad ticket to come to the United States was\nGOVERNOMENT PRENTING officm 14-\n(OVER)\n(Signature of applicant)"
}