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1st cabin
If by ship: Name of steamship line was
2d cabin
3d cabin
I arrived as (passeng stowaway, seaman, member of crew, or otherwise)
(State which)
I traveled on (an immigration 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
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
name in full)
The place in the United States I was going to was
The names of some of the persons or passengers I traveled with were
My last place of foreign residence was said Nola
(City
I am
{
wife
is Martha town)
(Country)
She
married. The name of my
hucband
He
}
was born at
Pomocna, Poland , and now resides at said chestnut Hill
I
am now a subject of and intend to renounce allegiance to the (Write Rzpublic of name and title of sovereign and country of which
now a subject;
Poland
or, if citizen of a Republic, write name of Republic only)
I arrived at the United States Immigration port of
new (State territory)
York
, on
new may (dive (City or exact 29 town) month, day, and year) 1911
forth
or
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
(f) The place in
{
Canada
Mexico
} where I bought my railroad ticket to come to the United States was
GOVERNMENT PRENTING 0F5702
e14-8
(Signature of applicant)
(OVER)
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
- b9ae16685f440adf
- 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": "1st cabin\nIf by ship: Name of steamship line was\n2d cabin\n3d cabin\nI arrived as (passeng stowaway, seaman, member of crew, or otherwise)\n(State which)\nI traveled on (an immigration a passport, a permit)\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 officers at\nAt that time I intended to remain (permanently, temporarily, for visit, in transit)\n(State which)\nThe person in the United States I was coming to was\nname in full)\nThe place in the United States I was going to was\nThe names of some of the persons or passengers I traveled with were\nMy last place of foreign residence was said Nola\n(City\nI am\n{\nwife\nis Martha town)\n(Country)\nShe\nmarried. The name of my\nhucband\nHe\n}\nwas born at\nPomocna, Poland , and now resides at said chestnut Hill\nI\nam now a subject of and intend to renounce allegiance to the (Write Rzpublic of name and title of sovereign and country of which\nnow a subject;\nPoland\nor, if citizen of a Republic, write name of Republic only)\nI arrived at the United States Immigration port of\nnew (State territory)\nYork\n, on\nnew may (dive (City or exact 29 town) month, day, and year) 1911\nforth\nor\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) (Day) (Year)\nCanada\n(b) The place in\nfrom which I entered the United States was\nMexico\n(c) On\n(Month)\n(Day)\nYear)\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\n(f) The place in\n{\nCanada\nMexico\n} where I bought my railroad ticket to come to the United States was\nGOVERNMENT PRENTING 0F5702\ne14-8\n(Signature of applicant)\n(OVER)"
}