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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 pergon shown on my steamship ticket was
My mother's maiden name was
My malden name was (if woman).
My post-office address is 179 Hickory Street, Norwich, Connecticut.
The ticket on which I came to this country was bought at
(City)
(Country)
1st cabin
If arrival by : 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
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
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
GOVERNMENT PRINTING OFFICE 14-8
(OVER)
Unders friend (Signature anderson of applicant)
Page data
- Page
- 286
- Source index
- 0
- Type
- photo
- Media ID
- 76cec3c2b1c66e8e
- Size
- unknown
Document data
- ID
- 159596813
- Core
- doc
- Type
- document
DTO data
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"title": "File numbers 4874 - 5509, 1926-1930",
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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 pergon shown on my steamship ticket was\nMy mother's maiden name was\nMy malden name was (if woman).\nMy post-office address is 179 Hickory Street, Norwich, Connecticut.\nThe ticket on which I came to this country was bought at\n(City)\n(Country)\n1st cabin\nIf arrival by : 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\nin 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\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\nGOVERNMENT PRINTING OFFICE 14-8\n(OVER)\nUnders friend (Signature anderson of applicant)"
}