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1st cabin
IT by ship: Name of steamship line was
2d cabin
3d cabin
I arrived as (passenger, stowaway, seaman, member of crew, or otherwise)
(State which)
I traveled on (an immigration visa, passport, a permit)
(State which)
I paid
head tax at
, on
(State amount)
(City)
(State or country)
(Month)
(Day)
(Year)
I was examined by immigration officers at
At that time I intended to remain (permanently temporarily, for VISIG in transit)
(State which)
The person in the United States was coming to was
(Give name in foll)
The place in the United States I was going to was
The names of some of the persons or passengers I traveled with were
said
My last place of foreign residence was A Kegyz wife (City
Poland
or town)
(Country)
I am not married. The name of my
(
She
is
husband
lie
}
was born at
, and now resides at
I am now a subject of and intend to renounce allegiance to
I guace White name and title of sovereign moscick and country of which now
a subject;
HaRzpublic
or, if citizen of a Republic, write name of Republic only) of Poland
I arrived at the United States Immigration port of
New york (City or town)/
city
New (State
York
, on
or territory)
april (Give 19, month, 1910 day, and
exact year)
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
(A)
The place in
Mexico
where I bought my railroad ticket to come to the United States was
GOVBRNMENT PRINTING
e14-8
(Signature of applicant)
(OVER)
Page data
- Page
- 71
- Source index
- 0
- Type
- photo
- Media ID
- daa93f226b5179aa
- 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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Document source extras
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Page context
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"ocrText": "1st cabin\nIT by ship: Name of steamship line was\n2d cabin\n3d cabin\nI arrived as (passenger, stowaway, seaman, member of crew, or otherwise)\n(State which)\nI traveled on (an immigration visa, passport, a permit)\n(State which)\nI paid\nhead tax at\n, on\n(State amount)\n(City)\n(State or country)\n(Month)\n(Day)\n(Year)\nI was examined by immigration officers at\nAt that time I intended to remain (permanently temporarily, for VISIG in transit)\n(State which)\nThe person in the United States was coming to was\n(Give name in foll)\nThe place in the United States I was going to was\nThe names of some of the persons or passengers I traveled with were\nsaid\nMy last place of foreign residence was A Kegyz wife (City\nPoland\nor town)\n(Country)\nI am not married. The name of my\n(\nShe\nis\nhusband\nlie\n}\nwas born at\n, and now resides at\nI am now a subject of and intend to renounce allegiance to\nI guace White name and title of sovereign moscick and country of which now\na subject;\nHaRzpublic\nor, if citizen of a Republic, write name of Republic only) of Poland\nI arrived at the United States Immigration port of\nNew york (City or town)/\ncity\nNew (State\nYork\n, on\nor territory)\napril (Give 19, month, 1910 day, and\nexact year)\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(A)\nThe place in\nMexico\nwhere I bought my railroad ticket to come to the United States was\nGOVBRNMENT PRINTING\ne14-8\n(Signature of applicant)\n(OVER)"
}