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Page 1203 of 1298
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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
Peter Mroz
I used that name because
it is American form of my Polish name
The full name of the person shown on my steamship was
ticket Piotr Mrosz
My mother's maiden name was
Christina monkowna
My maiden name was (if woman) -
My post-office address is
111 North Bank St. New Sondon
The ticket on which I came to this country was bought at
New London United States op.
(City)
(Country)
america
Holland america
lst -cabin
If arrival by ship: Name of steamship line was
ad eahin
3d cabin
3d cabin
I arrived as (passenger,
member
of
erow,
or
othorwige)
(State which)
I traveled on (an immigration visa, a passport, a permit)
none
(State which)
I paid
head tax at
don'T remember
, on
(State amount)
(City)
(State or country)
(Month)
(Day)
(Year)
I was examined by immigration officers at
New york, N.Y.
At that time I intended to remain for in
(permanently, temporarily, visit, transit) (State which)
permanently
The person in was coming to was
the United States I Leonora nowick
(sister)
(Give name in full)
The place in the United States I was going to was
New London, Comm
The of of the I traveled with don't remember.
names some persons or passengers 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)
(b) The place in
{
Canada
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
Piotoo most
GOVERNMENT PIMNTING OFFICE 14-8
(OVER)
(Signature of applicant)
Page data
- Page
- 1203
- Source index
- 0
- Type
- photo
- Media ID
- f7112a130e848a44
- 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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"core": "doc",
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Document source metadata
{
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"sourceUrl": "https://catalog.archives.gov/id/159596813",
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Document source extras
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"naId": 159596813,
"levelOfDescription": "fileUnit",
"onlineResources": [
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"note": "This file was scanned as part of a collaboration effort between FamilySearch and the National Archives.",
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"recordType": "description",
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Page context
{
"seq": 1203,
"pageIndex": 0,
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"ocrText": "I have - used another name in this country than that given'at the beginning of this form. If so, it was\nPeter Mroz\nI used that name because\nit is American form of my Polish name\nThe full name of the person shown on my steamship was\nticket Piotr Mrosz\nMy mother's maiden name was\nChristina monkowna\nMy maiden name was (if woman) -\nMy post-office address is\n111 North Bank St. New Sondon\nThe ticket on which I came to this country was bought at\nNew London United States op.\n(City)\n(Country)\namerica\nHolland america\nlst -cabin\nIf arrival by ship: Name of steamship line was\nad eahin\n3d cabin\n3d cabin\nI arrived as (passenger,\nmember\nof\nerow,\nor\nothorwige)\n(State which)\nI traveled on (an immigration visa, a passport, a permit)\nnone\n(State which)\nI paid\nhead tax at\ndon'T remember\n, on\n(State amount)\n(City)\n(State or country)\n(Month)\n(Day)\n(Year)\nI was examined by immigration officers at\nNew york, N.Y.\nAt that time I intended to remain for in\n(permanently, temporarily, visit, transit) (State which)\npermanently\nThe person in was coming to was\nthe United States I Leonora nowick\n(sister)\n(Give name in full)\nThe place in the United States I was going to was\nNew London, Comm\nThe of of the I traveled with don't remember.\nnames some persons or passengers were\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(b) The place in\n{\nCanada\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\nPiotoo most\nGOVERNMENT PIMNTING OFFICE 14-8\n(OVER)\n(Signature of applicant)"
}