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I have never used another name in this country than that given at the beginning of this form. If so, it was
I used that name because
X
The full name of the person shown on my steamship ticket was Knut Emprood Samuelsou
My mother's maiden name was Anna X Tarabarg
My maiden name was (if woman)
My post-office address is P.O. Box 27 - myster -form Fature - - Sweden
The ticket on which I came to this country was bought at
(City)
(Country)
If arrival by ship: Name of steamship line was Smedish american
lat cabin
2d cabin
3d cabin
3rd less
I arrived as (passenger, stowaway, seaman, member of crew, or otherwise) (State which)
Passenger
I traveled on (an immigration visa, a passport, a permit)
Passport
(State which)
I
paid 30KR (State amount) head tax at (City) (State country) on august (Month) (Day) 27Th-1926 (Year)
or
I was
examined by immigration officers at my
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 Richard Jedor
permanently
Samuelson
The place in the United States I was going to was
Providence - R.I
(Give name in full)
The names of some of the persons or passengers I traveled with were Arthur Sand
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
(f) The place in
Mexico
where I bought my railroad ticket to come to the United States was
PRINTING OFFICE
14-
(OVER)
Knot Erford (Signature of applicant) danue lson
Page data
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- Source index
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- Type
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- Media ID
- c16b4d12a1556bd4
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Document data
- ID
- 159596813
- Core
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- Type
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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": "I have never used another name in this country than that given at the beginning of this form. If so, it was\nI used that name because\nX\nThe full name of the person shown on my steamship ticket was Knut Emprood Samuelsou\nMy mother's maiden name was Anna X Tarabarg\nMy maiden name was (if woman)\nMy post-office address is P.O. Box 27 - myster -form Fature - - Sweden\nThe ticket on which I came to this country was bought at\n(City)\n(Country)\nIf arrival by ship: Name of steamship line was Smedish american\nlat cabin\n2d cabin\n3d cabin\n3rd less\nI arrived as (passenger, stowaway, seaman, member of crew, or otherwise) (State which)\nPassenger\nI traveled on (an immigration visa, a passport, a permit)\nPassport\n(State which)\nI\npaid 30KR (State amount) head tax at (City) (State country) on august (Month) (Day) 27Th-1926 (Year)\nor\nI was\nexamined by immigration officers at my\nAt that time\nI intended to remain (permanently, temporarily, for visit, in transit) (State which)\nThe person in the United States I was coming to was Richard Jedor\npermanently\nSamuelson\nThe place in the United States I was going to was\nProvidence - R.I\n(Give name in full)\nThe names of some of the persons or passengers I traveled with were Arthur Sand\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 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\nPRINTING OFFICE\n14-\n(OVER)\nKnot Erford (Signature of applicant) danue lson"
}