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8661 6 ryard Friend supres
I have
used another name in this country than that given at the beginning of this form. If so, it was
Shorma -
I used that name because
The full name of the person shown on my steamship ticket was
My mother's maidon name was
Mv maiden name was (if woman)
My post-office address is
The ticket on which I came to this country was bought at
(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)
(State which)
I traveled on (an immigration visa a 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 visit, in transit)
(State which)
The person in the United States I was coming 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 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
The place in
{
Canada
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
- 793
- Source index
- 0
- Type
- photo
- Media ID
- 4ee81a690bc30ef5
- 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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"core": "doc",
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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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Page context
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"pageIndex": 0,
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"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_00793.jpg",
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"ocrText": "8661 6 ryard Friend supres\nI have\nused another name in this country than that given at the beginning of this form. If so, it was\nShorma -\nI used that name because\nThe full name of the person shown on my steamship ticket was\nMy mother's maidon name was\nMv maiden name was (if woman)\nMy post-office address is\nThe ticket on which I came to this country was bought at\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)\n(State which)\nI traveled on (an immigration visa a 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 visit, in transit)\n(State which)\nThe person in the United States I was coming 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 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)\n{\nCanada\n(b) The place in\n}\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\nThe place in\n{\nCanada\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)"
}