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40 ORIGINAL JAKIDIAD UPS. DEPARTMENT OF LABOR NOS/DEPARTMENT OF LABOR ORIGINAL 8628 NATURAL .6M No. 8529 No. 1.0m S DECLARATION OFIINTENTION DECLARATION FINITENTION Invalid for all purposes seven years after the date hereof Unvalid for all purposes seven years fter the date hereof STATE OF CALIFORMIA nt SUPERIOR Court STATE DL In the Caunty of LOS Angeles erti nl In the SURERIOR The State of California. Court Caunty of Los Angetes ss: ss: The State of California of in and for Los Angeles County. lo of Patrick Shea in and for Los Angeles Connty, g, I van Boeko Pirjan aged 22 years, atta aged 30 years, occupation cigar Buenuse do declare on oath that my personal occupation Labour do declare on oath that my personal description is: Color white complexion medium height 6 feet inches, description is: complexiun Dark As. height 3 feet you 6 inches, weight 185 pounds, color of hair B lack color of eyes DK B some weight 153 pounds, colon of Jaink hair color of eyes Brown other visible distinctive marks none other visible distipative marks. W S born in Groun Dol, austrial and I I was born in Caherenien Caterry Ireland 1 on the 11th day of November anno Domini 1 8931 now reside on the 30 day of optin march anno, Domini I 585, now reside at 642 alp (Give number, st atreet, towa, Los and State.) angeles Cal or mapiles, Italy at emigrated to the United States of (Give America number atrees, from are elly or town, Queenstown les Angeles Incland Cal I emigrated to the United States of America from I on the Ivessel California than by veasel, haracter of conveyance or name of transportation my last on the vessel Arabie last (II the allen arrived otherwine company should be given.) (II the alien arrived foreign residence was Drain D ol, austria foreign residence was otherwing Cahereineen the character of conveyance or name Thenry company shouldy Ireland given. my It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign It is my bona fide intention. to renounce forever all allegiance and fidelity to any foreign prince, potentate, state, or sovereignty, and particularly to prince, potentate, state, or sovereignty, and particularly to Francis Joseph, Empetor of Austria and Apostelic Kies of Hungaryoof whom 1 am now a subject: N, of Grast Britain and new york on or about the 1st day drarrived at the port of New Your of whom I am now a subject: 1 arrived at the port of lo noa solt ta in the to noq adt to be in the State of new your State of of on tha January meth anno Dómini 1 9091 n.y on-or_about the 26 :diy am not an anarchist: I am not a of on april handme. anno Dommi 1 909 1 am not an anarchist: I am nota polygamist non a believer in the practice of polygamy; and it is my intention in good fäith polygamist nor la believer in the practice of polygamy: and it is my intention in good fäith to become a citizen of the United States of l'America and to permanently reside therein: toi become a citizen of the United States of America and to (permanently reside therein: SO HELP ME GOD. 2000 So HELP ME GOD. Jua Puroc le to Patrick Shea am oa (Original algnature of doclarent.) to only do suitto odi Subscribed and sworn to before me in the office of the Clerk of to brii to somo adt Subscribed and sworn to béfore me in the office of the Clerk of card Court this 23 day of man anno Domini 1915 pons and Court this of march anno Domini 191 COUNTY CLERK AND EX-OFFICIO OLERK OF 90 emano - are COUNTY CLESK AND EX-OFFICIO CLENG or H. J: Letande AND FOR THE COUNTY HY OF LOS/ANGELES, STATE OF CALIFORNIA. H:J: Estande: - STATÉ OF sill to Clerk of the Court. Clerk of the Court By diggs Himmer Despurtson Clerk. By Dep. 16-46 Clerk.

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    "ocrText": "40\nORIGINAL\nJAKIDIAD\nUPS. DEPARTMENT OF LABOR\nNOS/DEPARTMENT OF LABOR\nORIGINAL\n8628\nNATURAL\n.6M\nNo. 8529\nNo.\n1.0m\nS\nDECLARATION OFIINTENTION\nDECLARATION FINITENTION\nInvalid for all purposes seven years after the date hereof\nUnvalid for all purposes seven years fter the date hereof\nSTATE OF CALIFORMIA\nnt\nSUPERIOR Court\nSTATE DL\nIn the\nCaunty of LOS Angeles\nerti nl\nIn the\nSURERIOR\nThe State of California.\nCourt\nCaunty of Los Angetes\nss:\nss:\nThe State of California\nof\nin and for Los Angeles County.\nlo\nof\nPatrick Shea\nin and for Los Angeles Connty,\ng, I van Boeko Pirjan\naged 22 years,\natta\naged 30 years,\noccupation\ncigar Buenuse do\ndeclare on oath that my personal\noccupation\nLabour\ndo declare on oath that my personal\ndescription is: Color white complexion medium height 6 feet\ninches,\ndescription is: complexiun Dark As. height 3 feet you 6 inches,\nweight 185 pounds, color of hair B lack color of eyes DK B some\nweight 153 pounds, colon of Jaink hair color of eyes Brown\nother visible\ndistinctive marks none\nother visible distipative marks.\nW S born in Groun Dol, austrial and\nI\nI\nwas born in Caherenien Caterry Ireland\n1\non the 11th day of November anno Domini 1 8931 now reside\non the\n30 day of optin march anno, Domini I 585, now reside\nat 642 alp (Give number, st atreet, towa, Los and State.) angeles Cal\nor\nmapiles, Italy\nat emigrated to the United States of (Give America number atrees, from are elly or town, Queenstown les Angeles Incland Cal\nI emigrated to the United States of America from\nI\non the Ivessel\nCalifornia than by veasel, haracter of conveyance or name of transportation\nmy last\non the vessel Arabie\nlast\n(II the allen arrived otherwine company should be given.)\n(II\nthe\nalien\narrived\nforeign residence was\nDrain D ol, austria\nforeign residence was\notherwing Cahereineen the character of conveyance or name Thenry company shouldy Ireland given. my\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nIt is my bona fide intention. to renounce forever all allegiance and fidelity to any foreign\nprince, potentate, state, or sovereignty, and particularly to\nprince, potentate, state, or sovereignty, and particularly to\nFrancis Joseph, Empetor of Austria and Apostelic Kies of Hungaryoof whom 1 am now a subject:\nN, of Grast Britain and\nnew york\non or about the 1st day\ndrarrived at the port of New Your\nof whom I am now a subject:\n1 arrived at the port of\nlo noa solt ta in the\nto noq adt to be in the\nState\nof new your\nState of\nof on tha January meth anno Dómini 1 9091\nn.y\non-or_about the\n26 :diy\nam not an anarchist: I am not a\nof on april handme. anno Dommi 1 909 1 am not an anarchist: I am nota\npolygamist non a believer in the practice of polygamy; and it is my intention in good fäith\npolygamist nor la believer in the practice of polygamy: and it is my intention in good fäith\nto become a citizen of the United States of l'America and to permanently reside therein:\ntoi become a citizen of the United States of America and to (permanently reside therein:\nSO HELP ME GOD.\n2000\nSo HELP ME GOD.\nJua Puroc\nle to Patrick Shea am\noa\n(Original algnature of doclarent.)\nto\nonly do suitto odi Subscribed and sworn to before me in the office of the Clerk of\nto brii to somo adt Subscribed and sworn to béfore me in the office of the Clerk of\ncard Court this 23 day of man anno Domini 1915\npons and Court this of march\nanno Domini 191\nCOUNTY CLERK AND EX-OFFICIO OLERK OF\n90 emano - are\nCOUNTY CLESK AND EX-OFFICIO CLENG or\nH. J: Letande AND FOR THE COUNTY\nHY\nOF LOS/ANGELES, STATE OF CALIFORNIA.\nH:J: Estande: -\nSTATÉ OF\nsill\nto Clerk of the\nCourt.\nClerk of the\nCourt\nBy diggs Himmer Despurtson Clerk.\nBy Dep. 16-46 Clerk."
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