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I have not 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 nome of the person chown on my steamchip ticket wes
My mothor's maiden was
My maidon name was (if wolltan)
My post-office address is 152 sachem st norwich Connecticut
The
ticket on which I Callic to this country was bought ats
(City)
(Country)
1st cabin
If arrival by ship: Name of stoamehip line was
2d cabin
3d cabin
I arrived as (passengar, etowaway, seamany member of eraw, or otherwise)
(State which)
Ltraveled on (an immigration viga, a passport, a permit)
(State which)
head tax at
, on
(State amount)
(City)
(State or country)
(Month)
(Day)
(Year)
I
was examined by immigration officers atm
At that time I intended to romain (pormanontly, tomporarily, for visit, III transit)
(State which)
The person in the United Stateg I was conning to was
(Give name in full)
The place in the United States I was going to was.
The names of some of the persons or passengers Itravoled 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)
(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
GOVERNMENT PRINTING OFFICE 14-8
(OVER)
(Signature of applicant)
Page data
- Page
- 288
- Source index
- 0
- Type
- photo
- Media ID
- d76828de3f9ae01b
- Size
- unknown
Document data
- ID
- 159596813
- Core
- doc
- Type
- document
DTO data
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"title": "File numbers 4874 - 5509, 1926-1930",
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Context sent to Scholar
Document identity
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Document source metadata
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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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}
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"recordType": "description",
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Page context
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"pageIndex": 0,
"type": "photo",
"url": "https://s3.amazonaws.com/NARAprodstorage/lz/partnerships-0002/18-0177_US-MA/18-0177_US-MA_21/18-0177_US-MA_-4526886-CTN-Applications-for-Declaration-of--1926-1930/18-0177_US-MA_-4526886-CTN-Applications-for-Declaration-of--1926-1930_00288.jpg",
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"ocrText": "I have not used 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 nome of the person chown on my steamchip ticket wes\nMy mothor's maiden was\nMy maidon name was (if wolltan)\nMy post-office address is 152 sachem st norwich Connecticut\nThe\nticket on which I Callic to this country was bought ats\n(City)\n(Country)\n1st cabin\nIf arrival by ship: Name of stoamehip line was\n2d cabin\n3d cabin\nI arrived as (passengar, etowaway, seamany member of eraw, or otherwise)\n(State which)\nLtraveled on (an immigration viga, a passport, a permit)\n(State which)\nhead tax at\n, on\n(State amount)\n(City)\n(State or country)\n(Month)\n(Day)\n(Year)\nI\nwas examined by immigration officers atm\nAt that time I intended to romain (pormanontly, tomporarily, for visit, III transit)\n(State which)\nThe person in the United Stateg I was conning to was\n(Give name in full)\nThe place in the United States I was going to was.\nThe names of some of the persons or passengers Itravoled with 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\nGOVERNMENT PRINTING OFFICE 14-8\n(OVER)\n(Signature of applicant)"
}