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No. 531
Form ssos
TRIPLICATE
[Tobe afven to the person makiog
the Declaration)
STATES OF
Department of Commerce and Tahor
BUREAU OF IMMIGRATION AND NATURALIZATION
DIVISION OF NATURALIZATION
DECLARATION OF INTENTION
(Invalid for all purposes seven years after the date hereof)
UNITED STATES
In the
Circuit
Court
SOUTHERN DISTRIET of CALIFORNIA,
SS :
COUNTS 1 tani
of
the United Stores
Southern District of California, Southern Divism
3, Hurmwall
aged 31 years,
occupation
farmer
do affirm that my personal
declare on oath
description is: Color : White , complexion Hair , height 2 feet of inches,
weight 160 pounds, color of hair Light , color of eyes Blue
other visible distinctive marks' Siar before
;
Belgium
I was born in antwerp
,
on the
2%th day of December
anno
Domini 85% I now reside at Surrey Loo Angeles be California
I emigrated to the United States of America from Liverpool, England
n
on the vessel
" Denmark
(Ifthe allen arrived otherWise than by vessel, the of ; my last
character conreyanced name of transportation company should be given.)
foreign residence was
Antwerp Belgium
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
prince, potentate, state, or sovereignty, and particularly to Leopold II,
King cal Belgium
of which I am now a subject:I eitizen
arrived at the port of
new York
in the
State
Perritory of
new York
on or about the 10th day
Bistrict
of
august , 866 I am not an anarchist; I am not a
anno Domini
polygamist not 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.
for sworn to Hilliam (Original signature of 14th declarant.) Furnerall
Subscribed and before me this
afforned
[SEAL.]
st
day of June anno Domini 19 09
Wm. M. Van Dyke
United States Circuit
By Clerk of the Southern District of Deputy Clerk
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Context sent to Scholar
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"ocrText": "No. 531\nForm ssos\nTRIPLICATE\n[Tobe afven to the person makiog\nthe Declaration)\nSTATES OF\nDepartment of Commerce and Tahor\nBUREAU OF IMMIGRATION AND NATURALIZATION\nDIVISION OF NATURALIZATION\nDECLARATION OF INTENTION\n(Invalid for all purposes seven years after the date hereof)\nUNITED STATES\nIn the\nCircuit\nCourt\nSOUTHERN DISTRIET of CALIFORNIA,\nSS :\nCOUNTS 1 tani\nof\nthe United Stores\nSouthern District of California, Southern Divism\n3, Hurmwall\naged 31 years,\noccupation\nfarmer\ndo affirm that my personal\ndeclare on oath\ndescription is: Color : White , complexion Hair , height 2 feet of inches,\nweight 160 pounds, color of hair Light , color of eyes Blue\nother visible distinctive marks' Siar before\n;\nBelgium\nI was born in antwerp\n,\non the\n2%th day of December\nanno\nDomini 85% I now reside at Surrey Loo Angeles be California\nI emigrated to the United States of America from Liverpool, England\nn\non the vessel\n\" Denmark\n(Ifthe allen arrived otherWise than by vessel, the of ; my last\ncharacter conreyanced name of transportation company should be given.)\nforeign residence was\nAntwerp Belgium\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprince, potentate, state, or sovereignty, and particularly to Leopold II,\nKing cal Belgium\nof which I am now a subject:I eitizen\narrived at the port of\nnew York\nin the\nState\nPerritory of\nnew York\non or about the 10th day\nBistrict\nof\naugust , 866 I am not an anarchist; I am not a\nanno Domini\npolygamist not 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.\nfor sworn to Hilliam (Original signature of 14th declarant.) Furnerall\nSubscribed and before me this\nafforned\n[SEAL.]\nst\nday of June anno Domini 19 09\nWm. M. Van Dyke\nUnited States Circuit\nBy Clerk of the Southern District of Deputy Clerk"
}