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TRIPLICATE
No. 517
Form 2903
[To be alven to the person making
the Declaration]
STATES OF
Department of Commerce and Eabor
BUREAU OF IMMIGRATION AND NATURALIZATION
DIVISION OF NATURALIZATION
DECLARATION OF INTENTION
(Invalid for all purposes seven years after the date hereof)
In the
SUPERIOR Court
OF CALIFORNIA
DE CALIFORNIA.
ST.ATE/ 3. County of Los Matermal Angeles SS : do SUATE
- AMD FOR Lee ANGELES COUNTY,
aged yr years,
declare on oath that my personal
occupation description 186 is?) Color pounds, White color of hair Signature complexion color of affirm- eyes heigh S Strey feet 11 inches,
weight
other visible distinctive marks
in Hiverstory
Generation reside at ony 2623 : I the was born 13" Cartton day of July dengle Pap anno
Domini emigrated I to the United States of America from Welhelm Sources given.] ; my
I on the vessel residence [If democrate
Rumbry
last
the allen arrived otherwise thap/by vessel, the character of or name of transportation company should be
Company
prince, foreign It is my potentate, bona fide was state, intention or International sovereignty, to renounce and forever particularly all allegiance to Middle of which and fidelity I am now to 11- any a subject citieen foreign in
; I
arrived at the port
State
Territory of
of New York on or about the 29. day the
District of Fiby nor a believer in the , anno practice Domini of polygamy: I and 1 am it not is my an intention in good faith
give anarchist; I am not a
polygamist to become a citizen of the United States of America and to permanently reside therein
So HELP ME GOD.
the [SEAL, ] the
Subscribed and sworn before me (Original this signature 3013 of
E
anno Bablish Domini 5
Kan
day of
- of
By
11-2920 Clerh.
1
/
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"ocrText": "TRIPLICATE\nNo. 517\nForm 2903\n[To be alven to the person making\nthe Declaration]\nSTATES OF\nDepartment of Commerce and Eabor\nBUREAU OF IMMIGRATION AND NATURALIZATION\nDIVISION OF NATURALIZATION\nDECLARATION OF INTENTION\n(Invalid for all purposes seven years after the date hereof)\nIn the\nSUPERIOR Court\nOF CALIFORNIA\nDE CALIFORNIA.\nST.ATE/ 3. County of Los Matermal Angeles SS : do SUATE\n- AMD FOR Lee ANGELES COUNTY,\naged yr years,\ndeclare on oath that my personal\noccupation description 186 is?) Color pounds, White color of hair Signature complexion color of affirm- eyes heigh S Strey feet 11 inches,\nweight\nother visible distinctive marks\nin Hiverstory\nGeneration reside at ony 2623 : I the was born 13\" Cartton day of July dengle Pap anno\nDomini emigrated I to the United States of America from Welhelm Sources given.] ; my\nI on the vessel residence [If democrate\nRumbry\nlast\nthe allen arrived otherwise thap/by vessel, the character of or name of transportation company should be\nCompany\nprince, foreign It is my potentate, bona fide was state, intention or International sovereignty, to renounce and forever particularly all allegiance to Middle of which and fidelity I am now to 11- any a subject citieen foreign in\n; I\narrived at the port\nState\nTerritory of\nof New York on or about the 29. day the\nDistrict of Fiby nor a believer in the , anno practice Domini of polygamy: I and 1 am it not is my an intention in good faith\ngive anarchist; I am not a\npolygamist to become a citizen of the United States of America and to permanently reside therein\nSo HELP ME GOD.\nthe [SEAL, ] the\nSubscribed and sworn before me (Original this signature 3013 of\nE\nanno Bablish Domini 5\nKan\nday of\n- of\nBy\n11-2920 Clerh.\n1\n/"
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