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376
377
Repartment of Comuterce and
Repartment of Commence anh Waber
NATURALIZATION SERVICE
NATURALIZATION SERVICE
No. 5364
anda
ORICINAL
5365
No.
R
STATES OF
STATES OF
DECLARATION OF INTENTION
DECLARATION OF INTENTION
(layalid, for all purposes seven years after the date hereof)
(Invalid for all purposes seven years after the date hereof)
ST.4-7
In the SUPERIOR
Court
STMTC of
ss:
The State of California.
In the SUPERIOR
Caunty of Los Angeles
Court
Caunty of Los Angeles
in and for Los Angeles County.
ss:
of
The State of California.
ge, Heinrich Roth
aged 29
years,
g,
George Edmund Parker aged 33
of in and for Los County.
Failor
years,
occupation
do declare on oath that my personal
occupation Druggist
, do declare on oath that my personal
description is: Color White complexion Fair height 5 feet 7% Vinches,
description is: Color White complexion Dark height 5 feet 5 inches,
weight 160 pounds, color of hair Brown color of eyes Brown
weight 165 pounds, color of hair Black color of eyes Brown
other visible distinctive marks
none
other visible distinctive marks Sean on uffer lip.
I was born in
Katy Hungay
I
was born in Fr. of Glanford Wentworth Co. ,ontleansha
on. the
2nd
day of
July
anno Domini I 883; I now reside
on the
23
day of
Sept
at
2819 Falson at (Give number, asreet, Los city or town, and angelin State. leal
anno Domini I 879 I now reside
at
710 So Broadway (Give Los angel Col
LIVERPOOL, INGLAND
number, stryet, city or town,
I emigrated to the United States of America from
1 emigrated to the United States of America from
Winder Cenada
on the vessel
Hermany
: my last
(If the allen arrived otherwise than by veasel, the character
name of transportation company should be given.)
on the vessel
Cenadian Parific Rrs
: my last
Raty Hungary
(II the allen arrived by yousel, the character of conveyance of name of transportation company should be given.)
foreign residence was
foreign residence was
Filbury
out
Canada
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
prince, potentate, state, or sovereignty, and particularly to
prince, potentate, state, or sovereignty, and particularly to
Francis Francie Joseph, of Anstria and Apostolie King of Hungss
of whom I am now a subject
Ces. v, King of Great Britain and
of whom I am now a subject ;
Larrived at the port of
NEW YORK
in the
, on or about
the 12th day
1 arrived at the port of
DETROIT
,
in the
State of
NEW YORK
State of
much
on or about the
day
of
Sept
anno Domini 1910 I am not an anarchist: I am not a
of
Sept anno Domini I 897 I am not an anarchist; I am not a
polygamist nor a believer in the practice of polygamy; and it is my intention in good faith
polygamist nor a believer in the practice of polygamy; and it is my intention in good faith
to become a citizen of the United States of America and to permanently reside therein:
to become a citizen of the United States of America and to permanently reside therein:
So HELP ME GOD.
Heintich Roth
So HELP ME GOD.
(Orlglas) algnature of declarant.)
George Edmund (Original algnature of Parker
Subscribed and sworn to before me this
27th
Subscribed and sworn to before me this
27th
[SEAL ]
day of
Jan , 19! 3
anno Domini
[SEAL.]
day
of Jan anno Domini
191.5
COUNTY CLERK AND EX-OFFICIO CLERK OF
H. J. Lelande the SUFERIOR co. 17 AND FOR THE COUNTY
H. J. Leland's in AND EX-OPFICIO CLERK COUNTE
OF
6F Los ANCYCRS.STATE UF
Clerk of the
Court.
Clerk of the
Court
By
& Smith Dy Clerk.
By
Clack.
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"ocrText": "376\n377\nRepartment of Comuterce and\nRepartment of Commence anh Waber\nNATURALIZATION SERVICE\nNATURALIZATION SERVICE\nNo. 5364\nanda\nORICINAL\n5365\nNo.\nR\nSTATES OF\nSTATES OF\nDECLARATION OF INTENTION\nDECLARATION OF INTENTION\n(layalid, for all purposes seven years after the date hereof)\n(Invalid for all purposes seven years after the date hereof)\nST.4-7\nIn the SUPERIOR\nCourt\nSTMTC of\nss:\nThe State of California.\nIn the SUPERIOR\nCaunty of Los Angeles\nCourt\nCaunty of Los Angeles\nin and for Los Angeles County.\nss:\nof\nThe State of California.\nge, Heinrich Roth\naged 29\nyears,\ng,\nGeorge Edmund Parker aged 33\nof in and for Los County.\nFailor\nyears,\noccupation\ndo declare on oath that my personal\noccupation Druggist\n, do declare on oath that my personal\ndescription is: Color White complexion Fair height 5 feet 7% Vinches,\ndescription is: Color White complexion Dark height 5 feet 5 inches,\nweight 160 pounds, color of hair Brown color of eyes Brown\nweight 165 pounds, color of hair Black color of eyes Brown\nother visible distinctive marks\nnone\nother visible distinctive marks Sean on uffer lip.\nI was born in\nKaty Hungay\nI\nwas born in Fr. of Glanford Wentworth Co. ,ontleansha\non. the\n2nd\nday of\nJuly\nanno Domini I 883; I now reside\non the\n23\nday of\nSept\nat\n2819 Falson at (Give number, asreet, Los city or town, and angelin State. leal\nanno Domini I 879 I now reside\nat\n710 So Broadway (Give Los angel Col\nLIVERPOOL, INGLAND\nnumber, stryet, city or town,\nI emigrated to the United States of America from\n1 emigrated to the United States of America from\nWinder Cenada\non the vessel\nHermany\n: my last\n(If the allen arrived otherwise than by veasel, the character\nname of transportation company should be given.)\non the vessel\nCenadian Parific Rrs\n: my last\nRaty Hungary\n(II the allen arrived by yousel, the character of conveyance of name of transportation company should be given.)\nforeign residence was\nforeign residence was\nFilbury\nout\nCanada\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprince, potentate, state, or sovereignty, and particularly to\nprince, potentate, state, or sovereignty, and particularly to\nFrancis Francie Joseph, of Anstria and Apostolie King of Hungss\nof whom I am now a subject\nCes. v, King of Great Britain and\nof whom I am now a subject ;\nLarrived at the port of\nNEW YORK\nin the\n, on or about\nthe 12th day\n1 arrived at the port of\nDETROIT\n,\nin the\nState of\nNEW YORK\nState of\nmuch\non or about the\nday\nof\nSept\nanno Domini 1910 I am not an anarchist: I am not a\nof\nSept anno Domini I 897 I am not an anarchist; I am not a\npolygamist nor a believer in the practice of polygamy; and it is my intention in good faith\npolygamist nor a believer in the practice of polygamy; and it is my intention in good faith\nto become a citizen of the United States of America and to permanently reside therein:\nto become a citizen of the United States of America and to permanently reside therein:\nSo HELP ME GOD.\nHeintich Roth\nSo HELP ME GOD.\n(Orlglas) algnature of declarant.)\nGeorge Edmund (Original algnature of Parker\nSubscribed and sworn to before me this\n27th\nSubscribed and sworn to before me this\n27th\n[SEAL ]\nday of\nJan , 19! 3\nanno Domini\n[SEAL.]\nday\nof Jan anno Domini\n191.5\nCOUNTY CLERK AND EX-OFFICIO CLERK OF\nH. J. Lelande the SUFERIOR co. 17 AND FOR THE COUNTY\nH. J. Leland's in AND EX-OPFICIO CLERK COUNTE\nOF\n6F Los ANCYCRS.STATE UF\nClerk of the\nCourt.\nClerk of the\nCourt\nBy\n& Smith Dy Clerk.\nBy\nClack."
}