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Department of
IMMIGRAT
12025/30
PORT OF San Brancieso, January 14,1918.
The immigration records at this port show the following as to the alien named below:
Name of alien Bernhard Gusek
Date of arrival January 31, 1907.
Samuel Line. stated
Not
Name of vessel: . Mashona
Form 2908
TRIPLICATE
Nb. 432
[To be given to the person making
the Declaration)
STATES OF
Department of Commerte 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 S U P E R I 0 R
Court
STATE OF WASHINGTON,
SS :
of Wash. for Chehalis County.
COUNTY OF CHEHALIS.
aged 19
years,
3. Bernhard Franz Josef Gusek
do
declare on oath that my personal
occupation Sailer
-
description is: Color White
,
complexion fair
height 5 feet 8 inches,
weight 170
pounds, color of hair dark brown , color eyes
of Hazel
other visible distinctive marks Anchor and star tattooed on right fore arm
:
I
was
born in Rostock, Germany
on the
30th
day of Auguat
anno
,
Domini 1889
; I now reside at Aberdeen, Chehalia co. Washington.
I emigrated to the United States of America from Anthwerp, Belgium
; my last
on the vessel [If Bark the allen arrived Mashona otherwise than by vessel, the character of conveyance or name of transportation company should be given.)
foreign residence was Rostock, Germany.
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
prince, potentate, state, or sovereignty, and particularly to WILLIAM
II.
of which I am now a
subject
EMPEROR OF GERMANY
in the
,
arrived at the port of San Franciaco
State
on or about the
11th
day
of California
anno Domini I 907 : I am not an anarchist; I am not a
of February
,
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.
Benefand Janz Jonef quick
(Original of
Subscribed and sworn to before me this 12th
[SEALS
day of Auguat
anno Domini 19.09.
H Cierk Carboncl of tt
the 8
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- Core
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- Type
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"ocrText": "Department of\nIMMIGRAT\n12025/30\nPORT OF San Brancieso, January 14,1918.\nThe immigration records at this port show the following as to the alien named below:\nName of alien Bernhard Gusek\nDate of arrival January 31, 1907.\nSamuel Line. stated\nNot\nName of vessel: . Mashona\nForm 2908\nTRIPLICATE\nNb. 432\n[To be given to the person making\nthe Declaration)\nSTATES OF\nDepartment of Commerte 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 S U P E R I 0 R\nCourt\nSTATE OF WASHINGTON,\nSS :\nof Wash. for Chehalis County.\nCOUNTY OF CHEHALIS.\naged 19\nyears,\n3. Bernhard Franz Josef Gusek\ndo\ndeclare on oath that my personal\noccupation Sailer\n-\ndescription is: Color White\n,\ncomplexion fair\nheight 5 feet 8 inches,\nweight 170\npounds, color of hair dark brown , color eyes\nof Hazel\nother visible distinctive marks Anchor and star tattooed on right fore arm\n:\nI\nwas\nborn in Rostock, Germany\non the\n30th\nday of Auguat\nanno\n,\nDomini 1889\n; I now reside at Aberdeen, Chehalia co. Washington.\nI emigrated to the United States of America from Anthwerp, Belgium\n; my last\non the vessel [If Bark the allen arrived Mashona otherwise than by vessel, the character of conveyance or name of transportation company should be given.)\nforeign residence was Rostock, Germany.\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprince, potentate, state, or sovereignty, and particularly to WILLIAM\nII.\nof which I am now a\nsubject\nEMPEROR OF GERMANY\nin the\n,\narrived at the port of San Franciaco\nState\non or about the\n11th\nday\nof California\nanno Domini I 907 : I am not an anarchist; I am not a\nof February\n,\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.\nBenefand Janz Jonef quick\n(Original of\nSubscribed and sworn to before me this 12th\n[SEALS\nday of Auguat\nanno Domini 19.09.\nH Cierk Carboncl of tt\nthe 8"
}