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bz 1st cabin If by ship: Name of steamship line was 2d cabin 3rd 3d cabin I as or arrived (passenger, stowaway, seaman, member of crew, otherwise) (State which) Josenger I on a a traveled (an immigration visa, passport, permit) perind (State which) I paid no, head tax at on I was examined (State amount) by immigration officers at (City) Ellis (State or country) 4.1. , Island (Month) (Day) (Year) At that time I intended to remain visit, in transit) (permanently, temporarily, for (State which) The person in the United States I was coming to was much Sylvates (Give in full) perminently name, Rileck The place in the United States I was going to was Newark A. J. The names of some of the persons or passengers I traveled with were Najeial motyke paid My last place of foreign residence was wife (City or town) yours, Austria (Country) She groguing I am yes married. The name of my { busband Purny is Cheval guy He was born at Broslok Jolices, austra and now resides at 88 0, Otrabam Sh. Nomich I am now a subject of and intend to renounce allegiance to Pep (Write of name Palaced. sovereign and title of and country of which now a subject; or, if citizen of a Republic, write name of Republic I arrived at the United States Immigration only) port of New City or town new Wirk on 8-th 1900- Month, (State or territory) (Give exact month, day, and year) 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 5 (e) If not examined, state why, and give the circumstances of your entry Canada (f) The place in where I bought my railroad ticket to come to the United States was Mexico x Atutoni Pilecki GOVERNMENT PRINTING orficia e14-8 (Signature of applicant) (OVER)

Page data

Page
140
Source index
0
Type
photo
Media ID
ad8db42a5c781584
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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}