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Form 2803
No. 1917
TRIPLICATE
(To be given to the person makly
the Declaration)
STATES OF
Department of Conmmerce and Tahor
BUREAU OF IMMIGRATION AND NATURALIZATION
DIVISION OF NATURALIZATION
DECLARATION OF INTENTION
(Invalid for all purposes seven years after the date hereof)
STATE OF CALIFON
In the
County of Los Angeles
SUPERIOR Court
SS :
of THE STATE RE Los ANGELES COUNTE
3,
Jacob Fredinand Haller
, aged
41 years,
occupation
Burber
do declare affirm on oath that my personal
description is: Color white , complexion Light , height 5 feet 9. inches
weight 178. pounds, color of hair Brown , color of eyes trey
other visible distinctive marks
none
;
Hermany
I was born in Kmittlengen
, on the
nf H.
day of
Steptember
, anno
Domini I 868. I now reside at 185 so teastlance ar has Angeles bas
I emigrated to the United States of America from Rotterdam Holland
on the vessel
Edam
(If
the allen arrived otherwise than by vessel, the character of conveyange or name of transportation company should be given.)
; my last
foreign residence was
smitilingan
Germany
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
prince, potentate, state, or sovereignty, and particularly to William II
Empiron of Gurmany
of which I am now a eitizen-
subject
arrived at the port of
newyork
in the
State
Territory of
District
newyork
on or about the
28th day
of January
, anno Domini 882; 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.
Jacob
Indiana taller
of declarant.)
Subscribed and sworn affirmed to before me this
18th
[SEAL ]
day of november
anno Domini 909
C, Q. Keves
COUNTY AND
THE BUPS non COUGT IN AND FOR IT HEDOURTY
OF
Glerk
of
the OF LOS ANGELES, STATE OF CALIFORNIK
By
Deputy Clerk.
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- Source index
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- Type
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- Size
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Document data
- ID
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- Core
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- Type
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DTO data
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Context sent to Scholar
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Document source metadata
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Page context
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"ocrText": "Form 2803\nNo. 1917\nTRIPLICATE\n(To be given to the person makly\nthe Declaration)\nSTATES OF\nDepartment of Conmmerce and Tahor\nBUREAU OF IMMIGRATION AND NATURALIZATION\nDIVISION OF NATURALIZATION\nDECLARATION OF INTENTION\n(Invalid for all purposes seven years after the date hereof)\nSTATE OF CALIFON\nIn the\nCounty of Los Angeles\nSUPERIOR Court\nSS :\nof THE STATE RE Los ANGELES COUNTE\n3,\nJacob Fredinand Haller\n, aged\n41 years,\noccupation\nBurber\ndo declare affirm on oath that my personal\ndescription is: Color white , complexion Light , height 5 feet 9. inches\nweight 178. pounds, color of hair Brown , color of eyes trey\nother visible distinctive marks\nnone\n;\nHermany\nI was born in Kmittlengen\n, on the\nnf H.\nday of\nSteptember\n, anno\nDomini I 868. I now reside at 185 so teastlance ar has Angeles bas\nI emigrated to the United States of America from Rotterdam Holland\non the vessel\nEdam\n(If\nthe allen arrived otherwise than by vessel, the character of conveyange or name of transportation company should be given.)\n; my last\nforeign residence was\nsmitilingan\nGermany\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprince, potentate, state, or sovereignty, and particularly to William II\nEmpiron of Gurmany\nof which I am now a eitizen-\nsubject\narrived at the port of\nnewyork\nin the\nState\nTerritory of\nDistrict\nnewyork\non or about the\n28th day\nof January\n, anno Domini 882; I am not an anarchist: I am not\na\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.\nJacob\nIndiana taller\nof declarant.)\nSubscribed and sworn affirmed to before me this\n18th\n[SEAL ]\nday of november\nanno Domini 909\nC, Q. Keves\nCOUNTY AND\nTHE BUPS non COUGT IN AND FOR IT HEDOURTY\nOF\nGlerk\nof\nthe OF LOS ANGELES, STATE OF CALIFORNIK\nBy\nDeputy Clerk."
}