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DUPLICATE.
[EDITION OF 1917.]
26114
No.
[FORM FOR NATIVE CITIZEN.]
Issued
UNITED STATES OF AMERICA.
STATE OF Colorado
SS:
COUNTY OF El Paso
I, Blanche I. Lewis
a NATIVE AND LOYAL CITIZEN OF THE
,
UNITED STATES, hereby apply to the Department of State, at Washington, for a passport.
I solemnly swear that I was born at New Millport, Clearfield Countyin the State of
Pennsylvania
,
on or about the
23
day of June
1876 ** that
,
my I father
M. R. Liewis
husband
, was born in Perrysville, Pa.
,
and is now residingxatX
deceased
Hthat he emigrated to the United States from the port of
on or about
, 1
; that he resided
years, uninterruptedly, in
the United States, from 1
to
1
at
; that he was
naturalized as a citizen of the United States before the
Court
of
at
on
1
,
as shown by the accompanying Certificate of Naturalization]
never
that I have resided outside the United States at the following places for the following periods:
, from
to
, from
to
and that I am domiciled in the United States, my permanent residence being at Colorado Springs,
in the State of
Colorado
, where I follow the occupation of Nurse
My last passport was obtained from
on
,
and was
I am about to go abroad temporarily; and I
(Diposition of passport.)
intend to return to the United States within 3 months } with the purpose of residing and per-
years
forming the duties of citizenship therein; and I desire a passport for use in visiting the countries here-
inafter named for the following purpose:
England
Red Cross Work
(Name of country.)
(Object of visit.)
France
Red Cross Work
(Name of country.)
(Object of visit.)
(Name of country.)
(Object of visit.)
I intend to leave the United States from the port of
(Port of departure.)
sailing on board the
on
191
(Name of vessel.)
(Date of departure.)
OATH OF ALLEGIANCE.
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 evasion: So help meGod.
Blanche I. terms
(Signature of applicant.)
Sworn to before me this
19th day
COULTY
of September
1918
[SEAL OP COURT.]
Howkish
Clerk of the District
Court at Colorado Springs, Colo.
[OVER.]
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Document data
- ID
- 2661825
- Core
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- Type
- document
DTO data
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"ocrText": "TO\nDUPLICATE.\n[EDITION OF 1917.]\n26114\nNo.\n[FORM FOR NATIVE CITIZEN.]\nIssued\nUNITED STATES OF AMERICA.\nSTATE OF Colorado\nSS:\nCOUNTY OF El Paso\nI, Blanche I. Lewis\na NATIVE AND LOYAL CITIZEN OF THE\n,\nUNITED STATES, hereby apply to the Department of State, at Washington, for a passport.\nI solemnly swear that I was born at New Millport, Clearfield Countyin the State of\nPennsylvania\n,\non or about the\n23\nday of June\n1876 ** that\n,\nmy I father\nM. R. Liewis\nhusband\n, was born in Perrysville, Pa.\n,\nand is now residingxatX\ndeceased\nHthat he emigrated to the United States from the port of\non or about\n, 1\n; that he resided\nyears, uninterruptedly, in\nthe United States, from 1\nto\n1\nat\n; that he was\nnaturalized as a citizen of the United States before the\nCourt\nof\nat\non\n1\n,\nas shown by the accompanying Certificate of Naturalization]\nnever\nthat I have resided outside the United States at the following places for the following periods:\n, from\nto\n, from\nto\nand that I am domiciled in the United States, my permanent residence being at Colorado Springs,\nin the State of\nColorado\n, where I follow the occupation of Nurse\nMy last passport was obtained from\non\n,\nand was\nI am about to go abroad temporarily; and I\n(Diposition of passport.)\nintend to return to the United States within 3 months } with the purpose of residing and per-\nyears\nforming the duties of citizenship therein; and I desire a passport for use in visiting the countries here-\ninafter named for the following purpose:\nEngland\nRed Cross Work\n(Name of country.)\n(Object of visit.)\nFrance\nRed Cross Work\n(Name of country.)\n(Object of visit.)\n(Name of country.)\n(Object of visit.)\nI intend to leave the United States from the port of\n(Port of departure.)\nsailing on board the\non\n191\n(Name of vessel.)\n(Date of departure.)\nOATH OF ALLEGIANCE.\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 evasion: So help meGod.\nBlanche I. terms\n(Signature of applicant.)\nSworn to before me this\n19th day\nCOULTY\nof September\n1918\n[SEAL OP COURT.]\nHowkish\nClerk of the District\nCourt at Colorado Springs, Colo.\n[OVER.]"
}