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Form
No. 2690
TRIPLICATE
making
the
STATES OF enend
Then
The
First.
Department of Commerce and Tabor
Thtrd.
BUREAU OF IMMIGRATION AND NATURALIZATION
Fourth.
DIVISION OF NATURALIZATION
anno Dombit
anno Domini
DECLARATION OF INTENTION
(Invalid for all purposes seven years after the date hereof)
Slath.
/TE OF
In the
Court
cigy of Los M. write
SS :
THE STATE OF
of
IN AND FOR Los ANGFLER COUNTY,
3, Otto august Lines
aged 20
years,
occupation Cress buder
,
do declare on oath that my personal
description is: Color White complexion Fair height 5 feet 6 inches,
weight 135 pounds, color of hair Blonde color of eyes thay
other visible distinctive marks
None
intention
to
:
I was born in holfenbutter
to reside
Germany , on the 28
day of april
Eighth.
anno
Minth.
Domini 890 ; I now
reside
at Los angiles Calif
to
walk
12
I
emigrated to the United States of America from Haneburg Herminary
petition, since
camburg
petition
on the vessel
(If the allen arrived otherwise than by vessel, the character conveyance or name of transportation company should be given.]
; my last
Tenth.
foreign residence was
Holfenbitted Germany
said
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
prince, potentate, state, or sovereignty, and particularly to Aillian II
Attached
German Enchesor
Tabor, togeti
,
of which I am now a subject; I
the United State
arrived the port of Niw ynk
at
in the
State of
New and
on or about the
15 day
Declaration of Il
of
November , anno Domini I 1904 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
STAT
to become a citizen of the United States of America and to permanently reside therein:
Car
So HELP ME GOD.
The aforesa
contents thereof
(Original of declarant.)
information and
Subscribed and sworn to before me this
7th
[SEAL. ]
day of Sept
anno Domini 1910
and
C. a. Keyes
each belng
COUNTY ECERK TAND de
THE SUPERION COURT IN AND FOR THE COUNTY
DE LOS ANOBLES.BTATE OF CALIFORNIA.
impodiately
By Har Scott
Defuty Clerk.
entitled
the aold
do
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- Core
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"ocrText": "Form\nNo. 2690\nTRIPLICATE\nmaking\nthe\nSTATES OF enend\nThen\nThe\nFirst.\nDepartment of Commerce and Tabor\nThtrd.\nBUREAU OF IMMIGRATION AND NATURALIZATION\nFourth.\nDIVISION OF NATURALIZATION\nanno Dombit\nanno Domini\nDECLARATION OF INTENTION\n(Invalid for all purposes seven years after the date hereof)\nSlath.\n/TE OF\nIn the\nCourt\ncigy of Los M. write\nSS :\nTHE STATE OF\nof\nIN AND FOR Los ANGFLER COUNTY,\n3, Otto august Lines\naged 20\nyears,\noccupation Cress buder\n,\ndo declare on oath that my personal\ndescription is: Color White complexion Fair height 5 feet 6 inches,\nweight 135 pounds, color of hair Blonde color of eyes thay\nother visible distinctive marks\nNone\nintention\nto\n:\nI was born in holfenbutter\nto reside\nGermany , on the 28\nday of april\nEighth.\nanno\nMinth.\nDomini 890 ; I now\nreside\nat Los angiles Calif\nto\nwalk\n12\nI\nemigrated to the United States of America from Haneburg Herminary\npetition, since\ncamburg\npetition\non the vessel\n(If the allen arrived otherwise than by vessel, the character conveyance or name of transportation company should be given.]\n; my last\nTenth.\nforeign residence was\nHolfenbitted Germany\nsaid\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprince, potentate, state, or sovereignty, and particularly to Aillian II\nAttached\nGerman Enchesor\nTabor, togeti\n,\nof which I am now a subject; I\nthe United State\narrived the port of Niw ynk\nat\nin the\nState of\nNew and\non or about the\n15 day\nDeclaration of Il\nof\nNovember , anno Domini I 1904 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\nSTAT\nto become a citizen of the United States of America and to permanently reside therein:\nCar\nSo HELP ME GOD.\nThe aforesa\ncontents thereof\n(Original of declarant.)\ninformation and\nSubscribed and sworn to before me this\n7th\n[SEAL. ]\nday of Sept\nanno Domini 1910\nand\nC. a. Keyes\neach belng\nCOUNTY ECERK TAND de\nTHE SUPERION COURT IN AND FOR THE COUNTY\nDE LOS ANOBLES.BTATE OF CALIFORNIA.\nimpodiately\nBy Har Scott\nDefuty Clerk.\nentitled\nthe aold\ndo"
}