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Form 2903
No. 3191
TRIPLICATE
[To
the
DeclarationI
STATES OF
The
Department of Commerce and Tahor
Firs
BUREAU OF IMMIGRATION AND NATURALIZATION
DIVISION OF NATURALIZATION
Thin
Four
V
anno Domi
DECLARATION OF INTENTION
anno Domi
(Invalid for all purposes seven years after the date hereof)
Fiftl
In the
SUPERIOR Court
Sixtl
THE STATE OF CALIFORNIA
STATE OF CALIFORNI.4
ss :
County of Los Angeles
6
of
IN AND FOR LOS ANOALER COUNTY
aged 29 years,
3,
occupation description is: Color While complexion tair , height Brown
Bakery do declare on that my
oath personal
other visible distinctive marks Straight Hap on righter
weight 172 pounds, color of hair DarkBrgan color of eyes
Seven
: I was born in J&Bennet Franch
organize
intention to
on the
31
December anno
particulart
day of
to reside
Domini I 881 ; I now reside , at 571 Cires from are Have france TO
Eight
Yinth
I emigrated to the United States of America
the
on the vessel aquytaine therwise than by vessel, the character 7 France conveyance my
last
or name of transportation company should be given.)
this
petit
foreign residence (If the was arrived lap
Tenth,
It is bona fide intention to renounce forever all allegiance/and fidelity to any
foreign
prince, my particularly to French
mid
potentate, state, or sovereignty, and
Republic
of which I am now a subject: I
Attoch
new Your
In the
affidavit
arrived at the port of
28
State of new York
on or about the
day
October
, anno Domini I 900; I am not an anarchist: I am not a
Declar
of
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:
ST.
So HELP ME GOD.
Sleverly (Original Adrin signature declarant.) Cohita
of
18 th
The afo
Subscribed and sworn to before me this
there
march anno Domini 19 11
[SEAL.]
day of
H. J. LELANDE
COUNTY CLFUK AND L or
THE SUPERIOR COURT IN A.ID
By Clerk ofe CALIFORNA. Court
the OF LOS ANOELES,STAEE_OE
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Document data
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- Core
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- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "Form 2903\nNo. 3191\nTRIPLICATE\n[To\nthe\nDeclarationI\nSTATES OF\nThe\nDepartment of Commerce and Tahor\nFirs\nBUREAU OF IMMIGRATION AND NATURALIZATION\nDIVISION OF NATURALIZATION\nThin\nFour\nV\nanno Domi\nDECLARATION OF INTENTION\nanno Domi\n(Invalid for all purposes seven years after the date hereof)\nFiftl\nIn the\nSUPERIOR Court\nSixtl\nTHE STATE OF CALIFORNIA\nSTATE OF CALIFORNI.4\nss :\nCounty of Los Angeles\n6\nof\nIN AND FOR LOS ANOALER COUNTY\naged 29 years,\n3,\noccupation description is: Color While complexion tair , height Brown\nBakery do declare on that my\noath personal\nother visible distinctive marks Straight Hap on righter\nweight 172 pounds, color of hair DarkBrgan color of eyes\nSeven\n: I was born in J&Bennet Franch\norganize\nintention to\non the\n31\nDecember anno\nparticulart\nday of\nto reside\nDomini I 881 ; I now reside , at 571 Cires from are Have france TO\nEight\nYinth\nI emigrated to the United States of America\nthe\non the vessel aquytaine therwise than by vessel, the character 7 France conveyance my\nlast\nor name of transportation company should be given.)\nthis\npetit\nforeign residence (If the was arrived lap\nTenth,\nIt is bona fide intention to renounce forever all allegiance/and fidelity to any\nforeign\nprince, my particularly to French\nmid\npotentate, state, or sovereignty, and\nRepublic\nof which I am now a subject: I\nAttoch\nnew Your\nIn the\naffidavit\narrived at the port of\n28\nState of new York\non or about the\nday\nOctober\n, anno Domini I 900; I am not an anarchist: I am not a\nDeclar\nof\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:\nST.\nSo HELP ME GOD.\nSleverly (Original Adrin signature declarant.) Cohita\nof\n18 th\nThe afo\nSubscribed and sworn to before me this\nthere\nmarch anno Domini 19 11\n[SEAL.]\nday of\nH. J. LELANDE\nCOUNTY CLFUK AND L or\nTHE SUPERIOR COURT IN A.ID\nBy Clerk ofe CALIFORNA. Court\nthe OF LOS ANOELES,STAEE_OE"
}