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1st cabin
If by ship: Name of steamship line was
2d cabin
3d cabin
I arrived as (passenger, stowaway, seaman, member of crew, or otherwise)
(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
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
(Give 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 wife (City or town) (Country)
{
is Anna
Mikolajow
She
I am
married. The name of my
}
was born at
Repeg, talicia
husband and now resides at said Colchester He
,
I
am
now
subject of and intend to renounce allegiance to the (Write title of sovereign and country of which
Republic
name and now a subject;
Poland
or, if citizen of a Republic, write name of Republic only)
I arrived at the United States Immigration port of
(City or town)
new (State territory)
York
Newyfork
,
or
on (Give exact month, day,
august
9 1901
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)
(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
proton Disky
DOVINANMENT PRINTING
e14-8
(Signature of applicant)
(OVER)
Page data
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- Source index
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- Type
- photo
- Media ID
- ea77820f3de7f53b
- Size
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Document data
- ID
- 159596813
- Core
- doc
- Type
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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 (passenger, stowaway, seaman, member of crew, or otherwise)\n(State which)\nI traveled on (an immigration visa, 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\n(Give name 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 wife (City or town) (Country)\n{\nis Anna\nMikolajow\nShe\nI am\nmarried. The name of my\n}\nwas born at\nRepeg, talicia\nhusband and now resides at said Colchester He\n,\nI\nam\nnow\nsubject of and intend to renounce allegiance to the (Write title of sovereign and country of which\nRepublic\nname and now a subject;\nPoland\nor, if citizen of a Republic, write name of Republic only)\nI arrived at the United States Immigration port of\n(City or town)\nnew (State territory)\nYork\nNewyfork\n,\nor\non (Give exact month, day,\naugust\n9 1901\nand year)\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\nproton Disky\nDOVINANMENT PRINTING\ne14-8\n(Signature of applicant)\n(OVER)"
}