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369
U.S. DEPARTMENT OF LABOR
ORIGINAL
U.S. DEPARTMENT OF LABOR
ORIGINAL
No.
NATURALIZATION SERVICE
NATURALIZATION SERVICE
No
OF
STATES O
DECLARATION OF INTENTION
DECLARATION OF INTENTION
Invalid for all purposes seven years after the date hereof
Invalid for all purposes seven years after the date hereof
In the
Cour
In the
Court
ss:
of
of
i.
11. 11, 1 and Hindia aged
vears
1.
1111 11. (enner aged
years,
occupation
oath that my personal
oscupation
rescription is: Color 11hil comple I'll 111, height feet inches,
ini
de
Colo: u/1 complexion medium height feet 4 inches.
1.1. declare on oath that my personal
weight 111 pounds, color of har 1011'11 ,color of eves
my
weight " I pounds, color of hair
colorofeyes
jos
other visible tistinctive marks
11.
I was bom III
( ntairs (anands
ther visible distinctive marks
| was born in
(cause da
en the
dav.:
anno Domini
11.
- the
1.1 dav of
111
anno Domini -
11
I
reside
:
: (/ / /
&
.
-
"
"
K
1011
st.
United academ. America from limited xigenn '/ x : lu. last (a.19
States of
emigrated to the United States of
accessed,
the vessel
Diral
beautiful
(11 ........
is
reign residence was
All
MLAND
Rigene a, "aunada
intention to renounce forever all allegrance and indelity to any foreign
IS my bona tide intention to renounce forever all allegtance and indelity in any foreign
and particularly to
'ince, potentate, state, or sovereignty, and particularly to
it
Junna
of whom Iam now a subject:
"is
it whem
the portor
in the
parrived at the port of
, in the
Staterof
" ashungton
,on orabour the
11 day
State of
"
,on about the
day
of
fit
anno Donnimi 1.7 am not an anarchist: I am not
a
of
anno Domini I
: am not an anarchist: am nota
nor a behever 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 of the United States of America and to permanently reside therein:
10 become a citizen of the United States of America and to permanently resdetherem
So HELP ME GOD.
So HELP ME GOD.
alice mand Hindire
(original
Subscribed and sworn to before me/in the office of of
[SEAL.)
Court this ) day of tory anno Domini the Clerk 191
Subscribed and sworn to before me in the office of the Clerk of
(SEAL. I
Court this
davol
it
anno Domini 191
Clun of the
B1
pic Fanuill Clerk. Court
Clerk of the
Court.
b)
Clerk.
Page data
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Document data
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- Core
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- Type
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DTO data
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