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1129 stolis
No. 6049
TRIPLICATE
STATES OF
Bepartment of Commerce and Tabur
To the Honoro
The pet
BUREAU OF IMMIGRATION AND NATURALIZATION
A3M
First.
DIVISION OF NATURALIZATION
Second.
Third.
DECLARATION OF INTENTION
Fourth.
anno Domini
(Invalid for all purposes seven years after the date hereof)
anno Domini
1
State of California
SUPERIOR
1
In the
the State of California Court
SS :
at
City and Gounty of San Francicco
of In and for the City and County of San Francisco
Sinth.
3. Basilius Bagick aged 25
in
years,
I
have
Two
occupation batmet maker
do
declare on oath
affient
that my personal
description is: Color white complexion fair height feet 0
inches,
the
weight 164 pounds, color of hair blonder color of eyes flue
E
other visible distinctive marks
none
: I was born in Iniaten
Seventh.
Austrial on the 14th day of Ach
to organized go
intention to be
Domini 1883 I now reside , at 2822 Filtersh st Pitala anno
particularly to.
to reside perma
I
emigrated to the United States of America from Galican - Austria
Eighth. 1
Minth. I
on the vessel
: my last
(If the allen arrived otherwise than by vesseL the character of conveyance or chame of transportation company should be given.]
21
foreign residence wast Inalen - austria
patition, since ,
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
prince,
potentate, state, or sovereignty, and particularly to
Cenperor of Apptra
citizen
of which I am now a subject
I
arrived at the port of
Ken Jon
,
in the
State
Territery of
Dry
on or about the 21d day
District
of
may
anno Domini 906: 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
to become a citizen of the United States of America and to permanently reside therein:
So HELP ME GOD.
Busilius (Original signature of Bazink déclarant.)
Subscribed and sworn to before me this 23.
affirmed
[SEAL. ]
day of nov
, anno Domini 19 of
H. I. MULCREVY
Clerk of the
Superior Court.
By
Deputa.
11-9596
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- Type
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"ocrText": "1129 stolis\nNo. 6049\nTRIPLICATE\nSTATES OF\nBepartment of Commerce and Tabur\nTo the Honoro\nThe pet\nBUREAU OF IMMIGRATION AND NATURALIZATION\nA3M\nFirst.\nDIVISION OF NATURALIZATION\nSecond.\nThird.\nDECLARATION OF INTENTION\nFourth.\nanno Domini\n(Invalid for all purposes seven years after the date hereof)\nanno Domini\n1\nState of California\nSUPERIOR\n1\nIn the\nthe State of California Court\nSS :\nat\nCity and Gounty of San Francicco\nof In and for the City and County of San Francisco\nSinth.\n3. Basilius Bagick aged 25\nin\nyears,\nI\nhave\nTwo\noccupation batmet maker\ndo\ndeclare on oath\naffient\nthat my personal\ndescription is: Color white complexion fair height feet 0\ninches,\nthe\nweight 164 pounds, color of hair blonder color of eyes flue\nE\nother visible distinctive marks\nnone\n: I was born in Iniaten\nSeventh.\nAustrial on the 14th day of Ach\nto organized go\nintention to be\nDomini 1883 I now reside , at 2822 Filtersh st Pitala anno\nparticularly to.\nto reside perma\nI\nemigrated to the United States of America from Galican - Austria\nEighth. 1\nMinth. I\non the vessel\n: my last\n(If the allen arrived otherwise than by vesseL the character of conveyance or chame of transportation company should be given.]\n21\nforeign residence wast Inalen - austria\npatition, since ,\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprince,\npotentate, state, or sovereignty, and particularly to\nCenperor of Apptra\ncitizen\nof which I am now a subject\nI\narrived at the port of\nKen Jon\n,\nin the\nState\nTerritery of\nDry\non or about the 21d day\nDistrict\nof\nmay\nanno Domini 906: 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\nto become a citizen of the United States of America and to permanently reside therein:\nSo HELP ME GOD.\nBusilius (Original signature of Bazink déclarant.)\nSubscribed and sworn to before me this 23.\naffirmed\n[SEAL. ]\nday of nov\n, anno Domini 19 of\nH. I. MULCREVY\nClerk of the\nSuperior Court.\nBy\nDeputa.\n11-9596"
}