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121
No. 269
Formesos
TRIPLICATE
(To be gived te the person making
the Honorable the
the Declaration)
The petition of
STATES OF
First. My place
Second. My occu
Third. I was bor
Fourth. I emigre
Department nf Commerce and Tabor
anno Domini 90
BUREAU OF IMMIGRATION AND NATURALIZATION
anno Domini 90s
DIVISION' OF NATURALIZATION
Fifth. I declared
u
at
DECLARATION OF INTENTION
Sixth. I am
in
for an purposes after the date hereof)
1 have
childre
UNITED STATES OF AMERICA
SOUTIERN DISTRICT OF CALIFORNIA,
In the
Circuit
SS:
Court
COUNTY
description is: Color white complexion fair declare affirm height on oath s that feet my 8
occupation Sewing machine Operatory do
31, Chenry (Southern of the District United of California, States if
Inidor
Southern Division
aged years,
Seventh. I am n
personal
to organized governmen
weight 164 pounds, color of hair brown color of eyes
inches,
intention to become a
particularly to
other visible distinctive marks none
gray
to reside permanently il
Eighth. I am abl
: I was born in Uman Russia
Winth. I have res
in
17th day of January
27 day of
on the
petition, since the
Domini pay I now reside at 443 So Hilli California anno
petition.
I to the United States of America
emigrated Sealand from Antiverp. Belgium
Tenth. I have not
on
the vessel
said" petition was dented
foreign
residence was Uman, Russia
: my last
Attached hereto ai
It is my bona fide intention to renounce forever all allegiance, and fidelity to any foreign
together with
(
prince, Emperor potentate, state, or of sovereignty and particularly to, Nicholas 11, of which I am now a citizen
the United States of Am
arrived at the port of
new (your
subject I
Declaration of Inte
State
in the
Territory
District
of
June of new york , anno
on or about the 27th day
TATE
polygamist nor a believer in the practice of Relygamy: and it is my intention in good faith
Domini I goo I am not an anarchist: I am not a
The aforesaid petiti
to become a citizen of the United States of America and to permanently reside therein:
contents thereof that t
So HELP ME GOD.
information and belief, a
Isidar (Original Cherney declarant,
Viet
signature of
Subscribed and affirmed to before me this 3d
sworn
and
Theo
[SEAL.]
day of January
each being severally,
anno Domini 1908,
Wm. M. Van Dyke.
immediately preceding the
entitled petition is made
"If the allen arrived otherwise than by the character of conveyance or name thams of transportation company should Repunly be Eiven. Clerk.
By ahas n.
Cherk of the
United States Circuit
the said petitioner is a pi
Court.
District Californi
opinion, to be admitted a
11-9526
Subscribed and sworn to
anno Domini 1911
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"ocrText": "121\nNo. 269\nFormesos\nTRIPLICATE\n(To be gived te the person making\nthe Honorable the\nthe Declaration)\nThe petition of\nSTATES OF\nFirst. My place\nSecond. My occu\nThird. I was bor\nFourth. I emigre\nDepartment nf Commerce and Tabor\nanno Domini 90\nBUREAU OF IMMIGRATION AND NATURALIZATION\nanno Domini 90s\nDIVISION' OF NATURALIZATION\nFifth. I declared\nu\nat\nDECLARATION OF INTENTION\nSixth. I am\nin\nfor an purposes after the date hereof)\n1 have\nchildre\nUNITED STATES OF AMERICA\nSOUTIERN DISTRICT OF CALIFORNIA,\nIn the\nCircuit\nSS:\nCourt\nCOUNTY\ndescription is: Color white complexion fair declare affirm height on oath s that feet my 8\noccupation Sewing machine Operatory do\n31, Chenry (Southern of the District United of California, States if\nInidor\nSouthern Division\naged years,\nSeventh. I am n\npersonal\nto organized governmen\nweight 164 pounds, color of hair brown color of eyes\ninches,\nintention to become a\nparticularly to\nother visible distinctive marks none\ngray\nto reside permanently il\nEighth. I am abl\n: I was born in Uman Russia\nWinth. I have res\nin\n17th day of January\n27 day of\non the\npetition, since the\nDomini pay I now reside at 443 So Hilli California anno\npetition.\nI to the United States of America\nemigrated Sealand from Antiverp. Belgium\nTenth. I have not\non\nthe vessel\nsaid\" petition was dented\nforeign\nresidence was Uman, Russia\n: my last\nAttached hereto ai\nIt is my bona fide intention to renounce forever all allegiance, and fidelity to any foreign\ntogether with\n(\nprince, Emperor potentate, state, or of sovereignty and particularly to, Nicholas 11, of which I am now a citizen\nthe United States of Am\narrived at the port of\nnew (your\nsubject I\nDeclaration of Inte\nState\nin the\nTerritory\nDistrict\nof\nJune of new york , anno\non or about the 27th day\nTATE\npolygamist nor a believer in the practice of Relygamy: and it is my intention in good faith\nDomini I goo I am not an anarchist: I am not a\nThe aforesaid petiti\nto become a citizen of the United States of America and to permanently reside therein:\ncontents thereof that t\nSo HELP ME GOD.\ninformation and belief, a\nIsidar (Original Cherney declarant,\nViet\nsignature of\nSubscribed and affirmed to before me this 3d\nsworn\nand\nTheo\n[SEAL.]\nday of January\neach being severally,\nanno Domini 1908,\nWm. M. Van Dyke.\nimmediately preceding the\nentitled petition is made\n\"If the allen arrived otherwise than by the character of conveyance or name thams of transportation company should Repunly be Eiven. Clerk.\nBy ahas n.\nCherk of the\nUnited States Circuit\nthe said petitioner is a pi\nCourt.\nDistrict Californi\nopinion, to be admitted a\n11-9526\nSubscribed and sworn to\nanno Domini 1911"
}