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86 JAMID 180 ORIGINAL JAVIDIRO U.S.DEPARTMENT OF LABOR ORIGINAL No. 7574 ow No. 7575 STATES E DECLARATION OFOUNTENTION DECLARATION OFOINTENTION Invalid for all purposes seven years after the date hereof Trivalid for all purposes reven years after the daterhereof STATEOF CALIFORNIA adti ni In the SUPERIOR STATE OF CALIFORMIA 02 SUPERIOR Court ert) ni In the Court are Caunty of Los Angeles 22 The State of California. Caunty of Los Angeles ss: The State of California. of in and for Tos Angeles County. to ofn and for Los Angeles Counts. g, Leopold We Grand aged 33 years, 2709 g, John avart martineon aged 28 years, occupation manufacture do declare on oath that my personal occupation Dock worker do declare on oath that my personal description is: Color which complexion Fair height feet 8 inches, description issi Color white complexion Fair height feet inches, weight 142 pounds, color of hair Sandy , color of eyes Dr. Prown visible distinctive marks Scar Corner right Eye weight 140 pounds, colon of hair Sight none color of eyes Blue other other visible distinctive marks I was born in on the 31st day of onds Oct molenbeek St gean Belgium mod RNW. I was born in normaling Sweden anno Domini I 880 now reside E. 29 th st Lor angelic lears on the 21st day of august anno Domini I 895 1 now reside at at San Pedro, Cal (Give number, street, elty or town, (Give number, street, city or town, and State.) I emigrated to the United States of America from Sydney australia I emigrated to the United States of on the vessel Jahati Customa America from diverpool, England my last on the vessel : my last (If the alien arrived otherwise than " veasel, the character of conveyance or (name of transportation opmanay should be given.) (It the allen arrived otherwis than veasel, the character of conveyance or name Linansportation company should be given.) foreign residence was Sydney australia foreign residence was warsaw, Russia It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign my bona fidé 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 Albert I, King of the Belgians. of whom I am now a subject Gustavus V. King of Sweden. of whom I am now a subject: I arrived at the port of SAN FRANCISCO to in the I arrived at the port of California Sept. 201 august anno Domini d 909 I am not an anarchist: 1 am not of new you on or about the 21st day new york , in the State of , on or about the 5th day State of IM anno Domini- 912 I am not an anarchist I am not a of 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. So HELP ME GOD. .000 aus - o8 tempolis Be (Original dignature of Grave am, 9.13H- oe Johnavart (Original algnature Marlinson of declarant.) aidt 91 Subscribed and sworn to before me this 5th air ar Subscribed and sworn to before me this 5th [SEAL. ] almoa onns day of sang 2 1914 anno Domini [SBAL. nimoa day of aug , Domini anno 1914 COUNTY CLERK AND EX-OFFICIO CLERK OF QUNTY CLERK AND EX-OFFICIO CLERE of J: The FOR THE COUNTY or Los ANGELES. NATE OF CALIFORNIA. Extande OF MATE OF CALIFORNIA. sill to Clerk of the Court. sull in Clerk of the Court. By E.Smith Clerk. 16-36 By diggres Himini Deperty

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    "ocrText": "86\nJAMID 180\nORIGINAL\nJAVIDIRO\nU.S.DEPARTMENT\nOF\nLABOR\nORIGINAL\nNo. 7574\now\nNo. 7575\nSTATES\nE\nDECLARATION OFOUNTENTION\nDECLARATION OFOINTENTION\nInvalid for all purposes seven years after the date hereof\nTrivalid for all purposes reven years after the daterhereof\nSTATEOF CALIFORNIA\nadti\nni\nIn the SUPERIOR\nSTATE OF CALIFORMIA 02\nSUPERIOR\nCourt\nert)\nni\nIn the\nCourt\nare\nCaunty of Los Angeles\n22\nThe State of California.\nCaunty of Los Angeles\nss:\nThe State of California.\nof in and for Tos Angeles County.\nto\nofn and for Los Angeles Counts.\ng, Leopold We Grand\naged\n33\nyears,\n2709\ng, John avart martineon\naged 28\nyears,\noccupation manufacture\ndo declare on oath that my personal\noccupation Dock worker do declare\non oath that my personal\ndescription is: Color which complexion Fair height feet 8 inches,\ndescription issi Color white complexion Fair height feet inches,\nweight 142 pounds, color of hair Sandy , color of eyes Dr. Prown\nvisible distinctive marks Scar Corner right Eye\nweight 140 pounds, colon of hair Sight none color of eyes Blue\nother\nother visible distinctive marks\nI was born in\non\nthe 31st day of onds Oct\nmolenbeek St gean Belgium mod RNW.\nI\nwas born in normaling Sweden\nanno Domini I 880 now reside\nE. 29 th st Lor angelic lears\non the 21st day of august anno Domini I 895\n1 now reside\nat\nat\nSan Pedro, Cal\n(Give number, street, elty or town,\n(Give number, street, city or town, and State.)\nI emigrated to the United States of America from Sydney australia\nI emigrated to the United States of\non the vessel\nJahati\nCustoma America from diverpool, England\nmy last\non the vessel\n:\nmy\nlast\n(If the alien arrived otherwise than \" veasel, the character of conveyance or (name of transportation opmanay should be given.)\n(It the allen arrived otherwis than veasel, the character of conveyance or name Linansportation company should be given.)\nforeign residence was\nSydney australia\nforeign residence was\nwarsaw, Russia\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nmy bona fidé 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\nAlbert I, King of the Belgians.\nof whom I am now a subject\nGustavus V. King of Sweden.\nof whom I am now a subject:\nI arrived at the port of SAN FRANCISCO\nto in the\nI arrived at the port of\nCalifornia\nSept.\n201 august anno Domini d 909 I am not an anarchist: 1 am not\nof new you on or about the 21st day\nnew york\n, in the\nState of\n, on or about the\n5th\nday\nState\nof\nIM\nanno Domini- 912 I am not an anarchist I am not a\nof\na\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.\nSo HELP ME GOD.\n.000 aus - o8\ntempolis Be (Original dignature of Grave am, 9.13H- oe\nJohnavart (Original algnature Marlinson of declarant.)\naidt\n91 Subscribed and sworn to before me this\n5th\nair ar Subscribed and sworn to before me this\n5th\n[SEAL. ] almoa onns\nday of sang 2 1914\nanno Domini\n[SBAL. nimoa\nday\nof aug , Domini\nanno 1914\nCOUNTY CLERK AND EX-OFFICIO CLERK OF\nQUNTY CLERK AND EX-OFFICIO CLERE of\nJ:\nThe FOR THE COUNTY\nor Los ANGELES. NATE OF CALIFORNIA.\nExtande OF\nMATE OF CALIFORNIA.\nsill\nto Clerk of the\nCourt.\nsull in Clerk of the\nCourt.\nBy E.Smith\nClerk.\n16-36\nBy diggres Himini Deperty"
}