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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"
}