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DUPLICATE.
[EDITION OF 1915.]
No.
[FORM FOR NATIVE CITIZEN.]
Issued
M
UNITED STATES OF AMERICA.
Ts.
STATE OF Pennsylvania
COUNTY OF Budford
ss:
num married
I, Bertha Carmelia mangle 1 , a NATIVE AND LOYAL
CITIZEN OF THE
UNITED STATES, hereby apply to the Department of State, at Washington, for a passport.
The England and Examen
ban
Monoring
botala add
to mosifio a ad of
I solemnly swear that I was born at
Enratt
in the State of
bna 10 Jand end
Ammy father , on or about the 27 day of , 1882;*
that
my
husband
Thousas maugle
,
was born in ;
tht ho emigrated to the United States from the port
,
on or about
,
1
; that he resided
56
years, uninterruptedly, in
the United States, from 1 birth to 1 death , at that he was
naturalized as a citizen of the United Statos boforo the
Court
of
, at
,
on
, 1
, as shown by the accompanying Certificate of Naturalization];
that I am domiciled in the United States, my permanent residence being at
in the State of Pennsylonia , occupation nurse
where I follow the of
;
that I am about to go abroad temporarily; and I intend to return to the United States within
months
years
}
with the purpose of residing and performing the duties of citizenship therein; and that I desire
a passport for use in visiting the countries hereinafter named for the following purpose:
France
ofan Red bnan
(Name of country.)
(Object of visit.)
Last
England of
Under amprice of am Red Comes
(Name country.)
(Objeot of visit.)
(Name of country.)
(Object of visit.)
I intend to leave the United States from the port of Weby to orders (Port of departure.) ofam Ridbroud
sailing on board the (Name of vessel.) often Rdd roan (Date of departure.)
OATH OF ALLEGIANCE.
N
Further, I do solemnly swear that I will support and defend the Constitution of the United States
against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and
that I take this obligation freely, without any mental reservation or purpose of ovasion: So help me God.
Bertha (Signature Cornelia of applicant.) maugle
Sworn to before me this
21
day
of Septy
, 192
[SEAL OF COURT.]
AS
Ohan Ri moch
Clerk of the Commun Has Court ai. Bedford Pa
[OVER.]
ol-84
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- Type
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"logicalDate": "1945-11-12",
"month": 11,
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"ocrText": "DUPLICATE.\n[EDITION OF 1915.]\nNo.\n[FORM FOR NATIVE CITIZEN.]\nIssued\nM\nUNITED STATES OF AMERICA.\nTs.\nSTATE OF Pennsylvania\nCOUNTY OF Budford\nss:\nnum married\nI, Bertha Carmelia mangle 1 , a NATIVE AND LOYAL\nCITIZEN OF THE\nUNITED STATES, hereby apply to the Department of State, at Washington, for a passport.\nThe England and Examen\nban\nMonoring\nbotala add\nto mosifio a ad of\nI solemnly swear that I was born at\nEnratt\nin the State of\nbna 10 Jand end\nAmmy father , on or about the 27 day of , 1882;*\nthat\nmy\nhusband\nThousas maugle\n,\nwas born in ;\ntht ho emigrated to the United States from the port\n,\non or about\n,\n1\n; that he resided\n56\nyears, uninterruptedly, in\nthe United States, from 1 birth to 1 death , at that he was\nnaturalized as a citizen of the United Statos boforo the\nCourt\nof\n, at\n,\non\n, 1\n, as shown by the accompanying Certificate of Naturalization];\nthat I am domiciled in the United States, my permanent residence being at\nin the State of Pennsylonia , occupation nurse\nwhere I follow the of\n;\nthat I am about to go abroad temporarily; and I intend to return to the United States within\nmonths\nyears\n}\nwith the purpose of residing and performing the duties of citizenship therein; and that I desire\na passport for use in visiting the countries hereinafter named for the following purpose:\nFrance\nofan Red bnan\n(Name of country.)\n(Object of visit.)\nLast\nEngland of\nUnder amprice of am Red Comes\n(Name country.)\n(Objeot of visit.)\n(Name of country.)\n(Object of visit.)\nI intend to leave the United States from the port of Weby to orders (Port of departure.) ofam Ridbroud\nsailing on board the (Name of vessel.) often Rdd roan (Date of departure.)\nOATH OF ALLEGIANCE.\nN\nFurther, I do solemnly swear that I will support and defend the Constitution of the United States\nagainst all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and\nthat I take this obligation freely, without any mental reservation or purpose of ovasion: So help me God.\nBertha (Signature Cornelia of applicant.) maugle\nSworn to before me this\n21\nday\nof Septy\n, 192\n[SEAL OF COURT.]\nAS\nOhan Ri moch\nClerk of the Commun Has Court ai. Bedford Pa\n[OVER.]\nol-84"
}