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No. 854
Form
TRIPLICATE
STATES
Bepartment of Conmerce and Tabor
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
STATE OF CALIFORNIA
SS :
THE STATE OF CALIFORNIA,
County of Los Angeles
of
IN AND FOR Lee COUNTY,
3.
Dusan medan
aged
22 years,
occupation
Laberer
do affrem that my personal
declare on oath
description is: Color White complexion Light height feet 9
inches,
weigh 168 pounds, color of hair Black , color of eyes Blue
other visible distinctive marks
none
: I was born in
Stalac
Acastria
, on the
21st day of Nevember
anno
Domini I 885 I now reside at 704 Collage St Las Angeles bal
I emigrated to the
United States of America from Genoa Italy
on the vessel
La Savoie
; my last
[If the alien arrived otherwise than by vessel. the character of conveyance or name of transportation company should be given.
foreign residence was
Stalac Austria
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
prince, potentate, state, or sovereignty, and particularly to Francis Joseph
eitizen,
Euperor of Austria
of which I am now a subject
I
State
new york
in the
arrived at the port of
Territory of
Distejet
new york
on or about the 16th day
of
polygamist nor a believer in the practice of polygamy: and it is my intention in good faith
may
anno Domini I 900.1 am not an anarchist; I am not a
,
to become a citizen of the United States of America and-to permanently reside therein
So HELP ME GOD.
Dusan Medan
(Original signature of declarant.)
Subscribed and sworn affiemed to before me this 1st
[SEAL.]
day of give
anno Domini 199E
C. a. Keyes
COUNTY CLERK AND EX-OFFICIÓ GLERK or
THE SUPEDIOR COURT. IN AND FOR THE COUNTY
Clerk of ANGEL as. ATAM or GALIFONINIA,
Coun
M
By Research Deputy Clerk
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Document data
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Context sent to Scholar
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"ocrText": "No. 854\nForm\nTRIPLICATE\nSTATES\nBepartment of Conmerce and 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 SUPERIOR\nCourt\nSTATE OF CALIFORNIA\nSS :\nTHE STATE OF CALIFORNIA,\nCounty of Los Angeles\nof\nIN AND FOR Lee COUNTY,\n3.\nDusan medan\naged\n22 years,\noccupation\nLaberer\ndo affrem that my personal\ndeclare on oath\ndescription is: Color White complexion Light height feet 9\ninches,\nweigh 168 pounds, color of hair Black , color of eyes Blue\nother visible distinctive marks\nnone\n: I was born in\nStalac\nAcastria\n, on the\n21st day of Nevember\nanno\nDomini I 885 I now reside at 704 Collage St Las Angeles bal\nI emigrated to the\nUnited States of America from Genoa Italy\non the vessel\nLa Savoie\n; my last\n[If the alien arrived otherwise than by vessel. the character of conveyance or name of transportation company should be given.\nforeign residence was\nStalac Austria\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprince, potentate, state, or sovereignty, and particularly to Francis Joseph\neitizen,\nEuperor of Austria\nof which I am now a subject\nI\nState\nnew york\nin the\narrived at the port of\nTerritory of\nDistejet\nnew york\non or about the 16th day\nof\npolygamist nor a believer in the practice of polygamy: and it is my intention in good faith\nmay\nanno Domini I 900.1 am not an anarchist; I am not a\n,\nto become a citizen of the United States of America and-to permanently reside therein\nSo HELP ME GOD.\nDusan Medan\n(Original signature of declarant.)\nSubscribed and sworn affiemed to before me this 1st\n[SEAL.]\nday of give\nanno Domini 199E\nC. a. Keyes\nCOUNTY CLERK AND EX-OFFICIÓ GLERK or\nTHE SUPEDIOR COURT. IN AND FOR THE COUNTY\nClerk of ANGEL as. ATAM or GALIFONINIA,\nCoun\nM\nBy Research Deputy Clerk"
}