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Form ssoa
TRIPLICATE
STATES OF
(Tote the
Bepartment of Commerce aud Tabor
BUREAU OF IMMIGRATION AND NATURALIZATION
DIVISION OF NATURALIZATION
DECLARATION OF INTENTION
(Invalid for all purposes seven years after the date hereof)
In the
87.4TE OF
SS :
SUPERIOR Court
IN AND FOR Los ANGELES COUNTY
County of Los Angeles
of
THE STATE OF CALIFORNIA
3,
Slating Bernstiin
, aged
24 years,
description is: Color White complexion Dark
occupation Junk Dealer
.
, do declare on oath that my personal
,
height 5 feet </2inches,
weight 154 pounds, color of hair Black
, color of eyes
Brown
other visible distinctive marks
none
;
I was born in
Osda
Russia
,
on the
of april
anno
Domini I 887 ; I now reside at 667 Ehendia at Lasangeles leal
I emigrated the United States of America from Bremen Germany
to
on the vessel
(If the allen arrived otherwise than by versel, the character of conveyance or name of transportation company should be given.
Camaneg
; my last
Ton
foreign residence was
Asda Russia
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
prince, potentate, state, or sovereignty, and particularly to Nicholas II
Empire of all the Russians of
which I am now a subject; I
arrived at the port of
New York
,
in the
State of
New York on or about the
13th day
of
august
, anno Domini 9031 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.
slames Bention
the
(Original signature of declarant.)
Subscribed and sworn to before me this
17th
a
[SEAL.]
day of april
, anno Domini 1916
2
H.J. LELANDE
COUNTY CLERK AND EX-ORFICIO
the
THE - COORT IN AND FOR THE
Clerk of the OF LOS CALIFORNA Court.
By
E.S. Smith of Clerk.
the
)
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- Type
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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": "32% 3276\nForm ssoa\nTRIPLICATE\nSTATES OF\n(Tote the\nBepartment of Commerce aud Tabor\nBUREAU OF IMMIGRATION AND NATURALIZATION\nDIVISION OF NATURALIZATION\nDECLARATION OF INTENTION\n(Invalid for all purposes seven years after the date hereof)\nIn the\n87.4TE OF\nSS :\nSUPERIOR Court\nIN AND FOR Los ANGELES COUNTY\nCounty of Los Angeles\nof\nTHE STATE OF CALIFORNIA\n3,\nSlating Bernstiin\n, aged\n24 years,\ndescription is: Color White complexion Dark\noccupation Junk Dealer\n.\n, do declare on oath that my personal\n,\nheight 5 feet </2inches,\nweight 154 pounds, color of hair Black\n, color of eyes\nBrown\nother visible distinctive marks\nnone\n;\nI was born in\nOsda\nRussia\n,\non the\nof april\nanno\nDomini I 887 ; I now reside at 667 Ehendia at Lasangeles leal\nI emigrated the United States of America from Bremen Germany\nto\non the vessel\n(If the allen arrived otherwise than by versel, the character of conveyance or name of transportation company should be given.\nCamaneg\n; my last\nTon\nforeign residence was\nAsda Russia\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprince, potentate, state, or sovereignty, and particularly to Nicholas II\nEmpire of all the Russians of\nwhich I am now a subject; I\narrived at the port of\nNew York\n,\nin the\nState of\nNew York on or about the\n13th day\nof\naugust\n, anno Domini 9031 I am not an anarchist; I am not a\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.\nslames Bention\nthe\n(Original signature of declarant.)\nSubscribed and sworn to before me this\n17th\na\n[SEAL.]\nday of april\n, anno Domini 1916\n2\nH.J. LELANDE\nCOUNTY CLERK AND EX-ORFICIO\nthe\nTHE - COORT IN AND FOR THE\nClerk of the OF LOS CALIFORNA Court.\nBy\nE.S. Smith of Clerk.\nthe\n)"
}