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Page 1053 of 1298
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I have
used another name in this country than that given at the beginning of this form. If so, it was
Herman Savanuck
I
used that name because is would the better mudisitional
The full name of the shown on steamship ticket was Haim SIWANIA
person my
My mother's maiden name was Dirira
My maiden name was (if woman)
-
My
post-office address is 35 Fairmount ST, norwich, Come
The ticket which I to this bought Brest-Ritoura Pulanl
on came country was at
(City)
(Country)
If arrival by ship: Name of steamship line was Bremen Line
1st oabin
2d cabin
3d cabin
I arrived as (passenger, stowaway, seaman, member of crew, or otherwise)
passenge
(State which)
I traveled on (an immigration visa, a passport, a permit)
permit
(State which)
I paid
head tax at
,on
(State amount)
(City)
(State or country)
(Month)
(Day)
(Year)
I was examined by immigration at
officers Ellis Isloud, 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 Isaae
Savanuck
primanently
(Give name in full)
The place in the United States I going new york City, my
was to was
The names of some of the persons or passengers I traveled with were
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)
(b) The place in
{
Canada
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
GOVERNMENT PRINTING 14-
(OVER)
(Signature of applicant)
Page data
- Page
- 1053
- Source index
- 0
- Type
- photo
- Media ID
- 4fe44a0e91ec9310
- Size
- unknown
Document data
- ID
- 159596813
- Core
- doc
- Type
- document
DTO data
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"title": "File numbers 4874 - 5509, 1926-1930",
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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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"pageIndex": 0,
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"url": "https://s3.amazonaws.com/NARAprodstorage/lz/partnerships-0002/18-0177_US-MA/18-0177_US-MA_21/18-0177_US-MA_-4526886-CTN-Applications-for-Declaration-of--1926-1930/18-0177_US-MA_-4526886-CTN-Applications-for-Declaration-of--1926-1930_01053.jpg",
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"ocrText": "I have\nused another name in this country than that given at the beginning of this form. If so, it was\nHerman Savanuck\nI\nused that name because is would the better mudisitional\nThe full name of the shown on steamship ticket was Haim SIWANIA\nperson my\nMy mother's maiden name was Dirira\nMy maiden name was (if woman)\n-\nMy\npost-office address is 35 Fairmount ST, norwich, Come\nThe ticket which I to this bought Brest-Ritoura Pulanl\non came country was at\n(City)\n(Country)\nIf arrival by ship: Name of steamship line was Bremen Line\n1st oabin\n2d cabin\n3d cabin\nI arrived as (passenger, stowaway, seaman, member of crew, or otherwise)\npassenge\n(State which)\nI traveled on (an immigration visa, a passport, a permit)\npermit\n(State which)\nI paid\nhead tax at\n,on\n(State amount)\n(City)\n(State or country)\n(Month)\n(Day)\n(Year)\nI was examined by immigration at\nofficers Ellis Isloud, my\nAt\nthat time I intended to remain (permanently, temporarily, for visit, in transit) (State which)\nThe person in the United States I was coming to was Isaae\nSavanuck\nprimanently\n(Give name in full)\nThe place in the United States I going new york City, my\nwas to was\nThe names of some of the persons or passengers I traveled with were\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)\n(b) The place in\n{\nCanada\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\nGOVERNMENT PRINTING 14-\n(OVER)\n(Signature of applicant)"
}