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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
Rose Wein
I used
that name because my father used same.
The full name of the person shown on my steamship ticket was Rose Wyczauski
My mother's maiden name was
Zelda Goldberg
My maiden name was (if woman)
My post-office address is
17 Grand Street, New London, Conn.
The ticket on which I came to this country was bought at
(City)
(Country)
1st cabin
If arrival by ship: Name of steamship line was
Tarashta
2d cabin
3rd Cabin
3d cabin
I arrived as (passenger, stowaway, seaman, member of crew, or otherwise)
Passenger
(State which)
I
traveled on (an immigration visa, a passport, a permit)
(State which)
I paid
head tax at
on
(State amount)
(City)
(State or country)
(Month)
(Day)
(Year)
I was examined by immigration officers at
Ellis Island
At that time I intended to remain (permanently, temporarily, for visit, in transit)
Permanently
(State which)
The person in the United States I was coming to was
My Father
(Give name in full)
The place in the United States I was going to was Westerly, R. I.
The names of some of the persons or passengers I traveled with were
Zelda, Mother.
and brothers, Abraham, Maurice and Daniel.
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
Rose Wein
GOVERNMENT PRENTING ornon
14-
(OVER)
(Signature of applicant)
Page data
- Page
- 1134
- Source index
- 0
- Type
- photo
- Media ID
- c7d89af35b099603
- Size
- unknown
Document data
- ID
- 159596813
- Core
- doc
- Type
- document
DTO data
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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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"ocrText": "I have\nused another name in this country than that given at the beginning of this form. If so, it was\nRose Wein\nI used\nthat name because my father used same.\nThe full name of the person shown on my steamship ticket was Rose Wyczauski\nMy mother's maiden name was\nZelda Goldberg\nMy maiden name was (if woman)\nMy post-office address is\n17 Grand Street, New London, Conn.\nThe ticket on which I came to this country was bought at\n(City)\n(Country)\n1st cabin\nIf arrival by ship: Name of steamship line was\nTarashta\n2d cabin\n3rd Cabin\n3d cabin\nI arrived as (passenger, stowaway, seaman, member of crew, or otherwise)\nPassenger\n(State which)\nI\ntraveled on (an immigration visa, a passport, a permit)\n(State which)\nI paid\nhead tax at\non\n(State amount)\n(City)\n(State or country)\n(Month)\n(Day)\n(Year)\nI was examined by immigration officers at\nEllis Island\nAt that time I intended to remain (permanently, temporarily, for visit, in transit)\nPermanently\n(State which)\nThe person in the United States I was coming to was\nMy Father\n(Give name in full)\nThe place in the United States I was going to was Westerly, R. I.\nThe names of some of the persons or passengers I traveled with were\nZelda, Mother.\nand brothers, Abraham, Maurice and Daniel.\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\nRose Wein\nGOVERNMENT PRENTING ornon\n14-\n(OVER)\n(Signature of applicant)"
}