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I have not used another name in this country than that given at the beginning of this form. If so, it was
I used that name because
The full name of the person shown on my steamship ticket was John time
My mother's maiden name was Rosa mateine
My maiden name was (if woman)
My post-office address is
The ticket on which came to was at
I this country bought Bretanka, (City) azones, Portugal (Country)
If arrival by ship: Name of steamship line was white Star Lina
1st cabin
2d cabin-
3d Cabin
3d cabin
I arrived as (passenger, stowaway, seaman, member of crew, or otherwise)
passenger.
(State lich)
I traveled on (an immigration visa, a passport, a permit)
passport
(State which)
I paid mo head tax at
, on
(State amount)
(City)
(State or country)
(Month)
(Day)
(Year)
I was examined by immigration officers at WB rad ship.
At
that time I intended to remain (permanently, temporarily, for visit, in transit) (State which)
permanently
The person in the United States I was coming to was manual aguiar
(Give name in full)
The place in the United States I was going to was Hall R were, mass.
The names of some of the or I traveled with were Dr not know,
persons passengers
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)
Canada
(b) The place in
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 PRMNTING OFFICE
14
(OVER)
(Signature of applicant)
Page data
- Page
- 1175
- Source index
- 0
- Type
- photo
- Media ID
- f83d9613dc32fa7e
- 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 not used another name in this country than that given at the beginning of this form. If so, it was\nI used that name because\nThe full name of the person shown on my steamship ticket was John time\nMy mother's maiden name was Rosa mateine\nMy maiden name was (if woman)\nMy post-office address is\nThe ticket on which came to was at\nI this country bought Bretanka, (City) azones, Portugal (Country)\nIf arrival by ship: Name of steamship line was white Star Lina\n1st cabin\n2d cabin-\n3d Cabin\n3d cabin\nI arrived as (passenger, stowaway, seaman, member of crew, or otherwise)\npassenger.\n(State lich)\nI traveled on (an immigration visa, a passport, a permit)\npassport\n(State which)\nI paid mo head tax at\n, on\n(State amount)\n(City)\n(State or country)\n(Month)\n(Day)\n(Year)\nI was examined by immigration officers at WB rad ship.\nAt\nthat time I intended to remain (permanently, temporarily, for visit, in transit) (State which)\npermanently\nThe person in the United States I was coming to was manual aguiar\n(Give name in full)\nThe place in the United States I was going to was Hall R were, mass.\nThe names of some of the or I traveled with were Dr not know,\npersons passengers\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)\nCanada\n(b) The place in\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\nf The place in\nMexico\nwhere I bought my railroad ticket to come to the United States was\nGOVERNMENT PRMNTING OFFICE\n14\n(OVER)\n(Signature of applicant)"
}