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Form 2203
No. 2694
TRIPLICATE
[To be given to the gerage making
Declaration
STATES OF
Department of Commerce and Tabor
BUREAU OF IMMIGRATION AND NATURALIZATION
DIVISION OF NATURALIZATION
DECLARATION OF INTENTION
(Invalid for all purposes seven years after the date hereof)
NTATE OF CALIFORNIA
In the
County of Los Angeles
SUPERIOR Court
ss :
of THE STATE OF IN AND FOR CALIFORNIA Los ANGELE COUNTY,
Mys Hillay Grafia Johnson
aged
30 years,
occupation
nurse
do declare on oath that my personal
description is: Color
white
complexion
Fair
height
feet
inches,
weight 145 pounds, color of hair Brown color of eyes Blue
other visible distinctive marks
none
: I was born in
Hara
American
on the
9
day of
October
anno
Domini I 879: I now reside
at
Las Payrles Eal
no
I emigrated to the United States of America from Deverpool Tayfand
on the vessel [If allen arrived otherwis Gurnia Akara by vessel,
my last
the
character
of
convey
Ince
or
nage of transportation company should be given.
Amerin
st
foreign residence was
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
prinçe, potentate, state. or sovereignty, and particularly to Gustavus
King of Anchro
of which I am now a subject; I
arrived at the port of
Newyork
in the
State of
newyork
on or about the
23
day
of April
, anno Domini 900 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.
min (Original signature declarant.) J
Heldasperefie
of
Subscribed and sworn to before me this
st
[SEAL ]
day of September
anno Domini 19 10
C. G. Keyes
COUNTY CLERK AND EX OFFICIO CLERK of
THE SUPERIOR COURT IN AND FOR THE COUNT
Clerh of theo LOS CALIFORNIA
By
fixancy Appetry Clerk
th.
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- Source index
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- Type
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Document data
- ID
- 103954624
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
Document identity
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Document source metadata
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Document source extras
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Page context
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"ocrText": "Form 2203\nNo. 2694\nTRIPLICATE\n[To be given to the gerage making\nDeclaration\nSTATES OF\nDepartment of Commerce and Tabor\nBUREAU OF IMMIGRATION AND NATURALIZATION\nDIVISION OF NATURALIZATION\nDECLARATION OF INTENTION\n(Invalid for all purposes seven years after the date hereof)\nNTATE OF CALIFORNIA\nIn the\nCounty of Los Angeles\nSUPERIOR Court\nss :\nof THE STATE OF IN AND FOR CALIFORNIA Los ANGELE COUNTY,\nMys Hillay Grafia Johnson\naged\n30 years,\noccupation\nnurse\ndo declare on oath that my personal\ndescription is: Color\nwhite\ncomplexion\nFair\nheight\nfeet\ninches,\nweight 145 pounds, color of hair Brown color of eyes Blue\nother visible distinctive marks\nnone\n: I was born in\nHara\nAmerican\non the\n9\nday of\nOctober\nanno\nDomini I 879: I now reside\nat\nLas Payrles Eal\nno\nI emigrated to the United States of America from Deverpool Tayfand\non the vessel [If allen arrived otherwis Gurnia Akara by vessel,\nmy last\nthe\ncharacter\nof\nconvey\nInce\nor\nnage of transportation company should be given.\nAmerin\nst\nforeign residence was\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprinçe, potentate, state. or sovereignty, and particularly to Gustavus\nKing of Anchro\nof which I am now a subject; I\narrived at the port of\nNewyork\nin the\nState of\nnewyork\non or about the\n23\nday\nof April\n, anno Domini 900 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.\nmin (Original signature declarant.) J\nHeldasperefie\nof\nSubscribed and sworn to before me this\nst\n[SEAL ]\nday of September\nanno Domini 19 10\nC. G. Keyes\nCOUNTY CLERK AND EX OFFICIO CLERK of\nTHE SUPERIOR COURT IN AND FOR THE COUNT\nClerh of theo LOS CALIFORNIA\nBy\nfixancy Appetry Clerk\nth."
}