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Form 2903
No. 2078
TRIPLICATE
[Tobe siven the person making
the Declaration)
STATES OF
GRITED
Fourth
Domini
Department of Commerce and Tabor
anno Dominit 13
BUREAU OF IMMIGRATION AND NATURALIZATION
Finth Id
DIVISION OF NATURALIZATION
at
in
this
DECLARATION OF INTENTION
, have
a
(Invalid for all purposes seven years after the date hereof)
nato
STATE OP
In the Court
Hel
of 1.
SS :
IN ARD FOR Los ANDELES COUNTY,
of THE STATE
and
3.
Joseph Bernard
aged 27 years,
foay
Seventh.
Butcher
declare on oath
occupation
do affirm that my personal
to organized
intention to
description is:
Color which , complexion fair height
feet
inches,
particularly
weight 145 pounds, color of hair Brown color of eyes Blue
to reside
sighth.
other visible distinctive marks
none
Minth
:
I was born in
Champalion
the
20
this Retition,
France
on the
18
day of
October
anno
of
skate
Domini I 882; I now reside at
Lao Angeles bal
Tenth.
I emigrated to the United States of America from
Haver France
on the vessel
La Quitaine
; my last
[If the alien arrived otherwise than vessel. the character of conveyance or name of transportation company should be given.)
Attached
here
foreign residence was
Champaleon France.
my amdaut
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
prince, potentate, state, or sovereignty, and particularly to the French
Republic
citizen
Declaration
, of which I am now a subject I
arrived at the port of
newyork
in the
State
Tessitory of
newyork
on or about the
20' day
STATI
District of December
Caur
, anno Domini 901; I am not an anarchist; I am not a
polygamist nor a believer in the practice of polygamy; and it is my intention in good faith
to become a citizen of the United States of America and to permanently reside therein
Information
So HELP ME GOD.
Joseph (Original signature Bernard of declarant.)
or
Subscribed and sworn affiemed to before me this
/
[SEAL.
day of Beby
anno Domini 19 10
precedit
C. G. Keyer
AND EX ORFICIO et
THI COURT IN AND FOR
Clerk of the OF Loe STA - or CALIFORNIA,
By
generating
Deputy
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"ocrText": "Form 2903\nNo. 2078\nTRIPLICATE\n[Tobe siven the person making\nthe Declaration)\nSTATES OF\nGRITED\nFourth\nDomini\nDepartment of Commerce and Tabor\nanno Dominit 13\nBUREAU OF IMMIGRATION AND NATURALIZATION\nFinth Id\nDIVISION OF NATURALIZATION\nat\nin\nthis\nDECLARATION OF INTENTION\n, have\na\n(Invalid for all purposes seven years after the date hereof)\nnato\nSTATE OP\nIn the Court\nHel\nof 1.\nSS :\nIN ARD FOR Los ANDELES COUNTY,\nof THE STATE\nand\n3.\nJoseph Bernard\naged 27 years,\nfoay\nSeventh.\nButcher\ndeclare on oath\noccupation\ndo affirm that my personal\nto organized\nintention to\ndescription is:\nColor which , complexion fair height\nfeet\ninches,\nparticularly\nweight 145 pounds, color of hair Brown color of eyes Blue\nto reside\nsighth.\nother visible distinctive marks\nnone\nMinth\n:\nI was born in\nChampalion\nthe\n20\nthis Retition,\nFrance\non the\n18\nday of\nOctober\nanno\nof\nskate\nDomini I 882; I now reside at\nLao Angeles bal\nTenth.\nI emigrated to the United States of America from\nHaver France\non the vessel\nLa Quitaine\n; my last\n[If the alien arrived otherwise than vessel. the character of conveyance or name of transportation company should be given.)\nAttached\nhere\nforeign residence was\nChampaleon France.\nmy amdaut\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprince, potentate, state, or sovereignty, and particularly to the French\nRepublic\ncitizen\nDeclaration\n, of which I am now a subject I\narrived at the port of\nnewyork\nin the\nState\nTessitory of\nnewyork\non or about the\n20' day\nSTATI\nDistrict of December\nCaur\n, anno Domini 901; I am not an anarchist; I am not a\npolygamist nor a believer in the practice of polygamy; and it is my intention in good faith\nto become a citizen of the United States of America and to permanently reside therein\nInformation\nSo HELP ME GOD.\nJoseph (Original signature Bernard of declarant.)\nor\nSubscribed and sworn affiemed to before me this\n/\n[SEAL.\nday of Beby\nanno Domini 19 10\nprecedit\nC. G. Keyer\nAND EX ORFICIO et\nTHI COURT IN AND FOR\nClerk of the OF Loe STA - or CALIFORNIA,\nBy\ngenerating\nDeputy"
}