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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
annie Home.
My maiden name was (if woman)
My post-office address
is 148 gardnaluz form
The ticket on
which I came to this country was bought at Rock Island Duebee Canada
(City)
(Country)
1st cabin
If arrival by ship: Name of steamship line was
2d cabin
3d cabin
I arrived as (passenger, stowaway, seaman, member of crew, or otherwise)
passingie.
(State which)
I traveled on (an immigration visa, a passport, a permit)
personit.
$8.00 (State amount) head tax at Derby (City) Line (State Vermont, or ecuntry) on april (Month) (Day) 8th 1924. (Year)
(State which)
I paid
I was examined by immigration
officers at Dealy Line Vermont.
At that time I intended to remain (permanently, temporarily, for visit, in transit)
Temporarily
slint.
(State which)
The person in the United States I was coming to was
James (Give name in full)
Raymond
The place was to
in the United States I going was Waterfood Comm.
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
Mexico
which I entered the United States was Rock Island huebee
(c) On april Month)
8th
1924
(d) The place where I examined for (Day) admission at United (Year) States border was Derly Line
was the
Vermont
(e) If not examined, state why, and give the circumstances of your entry
Canada
(f) The place in
Moxico,
where I bought my railroad ticket to come to the United States was
Rock Island. Cheefec
GOVERNMENT PRENTING OFFICE 14-
(OVER)
grage (Signature of applicant)
Page data
- Page
- 702
- Source index
- 0
- Type
- photo
- Media ID
- 01d772997194079b
- 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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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\nannie Home.\nMy maiden name was (if woman)\nMy post-office address\nis 148 gardnaluz form\nThe ticket on\nwhich I came to this country was bought at Rock Island Duebee Canada\n(City)\n(Country)\n1st cabin\nIf arrival by ship: Name of steamship line was\n2d cabin\n3d cabin\nI arrived as (passenger, stowaway, seaman, member of crew, or otherwise)\npassingie.\n(State which)\nI traveled on (an immigration visa, a passport, a permit)\npersonit.\n$8.00 (State amount) head tax at Derby (City) Line (State Vermont, or ecuntry) on april (Month) (Day) 8th 1924. (Year)\n(State which)\nI paid\nI was examined by immigration\nofficers at Dealy Line Vermont.\nAt that time I intended to remain (permanently, temporarily, for visit, in transit)\nTemporarily\nslint.\n(State which)\nThe person in the United States I was coming to was\nJames (Give name in full)\nRaymond\nThe place was to\nin the United States I going was Waterfood Comm.\nThe names of some of the persons or passengers I traveled 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)\nCanada\n(b) The place in\nfrom\nMexico\nwhich I entered the United States was Rock Island huebee\n(c) On april Month)\n8th\n1924\n(d) The place where I examined for (Day) admission at United (Year) States border was Derly Line\nwas the\nVermont\n(e) If not examined, state why, and give the circumstances of your entry\nCanada\n(f) The place in\nMoxico,\nwhere I bought my railroad ticket to come to the United States was\nRock Island. Cheefec\nGOVERNMENT PRENTING OFFICE 14-\n(OVER)\ngrage (Signature of applicant)"
}