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OCR
120432
Form
TRIPLICATE
No. 3068
STATES OF
Department of Commerce and Tabor
BUREAU OF IMMIGRATION AND NATURALIZATION
DIVISION OF NATURALIZATION
a
Domini
INDEXED
DECLARATION OF INTENTION VRECEIVED
M
Fifth.
P.
:AUG 1 19
(Invalid for all purposes seven years after the date hereof)
BUREAU OF
NATURALIZATION
Sixth.
UNITED STATES OF AMERICA
In the
U. S. GEREMINED
Court
DISTRICT OF MAS CACHUSETIS
firth
SS :
DISTRICI OF MASCACHUSETTS
3. (dalpla Brinas
aged 25 years,
occupation Grocery clerk
do declare afferm on oath that my personal
description is: Color white complexion darh height 5 feet 3 inches,
toad
weight 13 t pounds, color of hair black , color of eyes brown
Seventh
to organized gou
other visible distinctive marks
none
intention to beco
; I was born in Tuchym Curland
particularly to
Russer
the 15th day of march
to reside perman
on
anno
Eighth. ,
Domini I 882 I now reside at / 3 Kennard
Vinth
I emigrated to the United States of America from4 Southas storteny
the
this petition, sir
on the vessel St Paul
[Iftheallen arrived otberwise than by vessel the character of conveyance or name of transportation company should be given. ;
my last
of,this petition
residence was South africa Kemberley
Tenth.
foreign
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
said-prittion was
prince, potentate, state, or sovereignty, and particularly to Micilas E
Attached he
Emperar
of which I am now a
citizon
subject
I
my affidanit and
arrived at the port of
new York
in the
State
Territory-of
new York
on or about the 10th day
District
Declaration
of august
,
anno Domini I 907 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:
STAT
Cau
So HELP ME GOD.
+ adalphand
The aforesar
(Original signature of declarant.)
contents thereof:
Subscribed
and affirmed sworn to before me this tenth
and 8
day of September anno Domini 1907
Z
Lb.Tucker,
Juh
Deputy
U, S. CIRCUIT
beint
Glerk of the
Court.
DISTRICT OF MASSACHUSETTS
madiately
pation
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"ocrText": "120432\nForm\nTRIPLICATE\nNo. 3068\nSTATES OF\nDepartment of Commerce and Tabor\nBUREAU OF IMMIGRATION AND NATURALIZATION\nDIVISION OF NATURALIZATION\na\nDomini\nINDEXED\nDECLARATION OF INTENTION VRECEIVED\nM\nFifth.\nP.\n:AUG 1 19\n(Invalid for all purposes seven years after the date hereof)\nBUREAU OF\nNATURALIZATION\nSixth.\nUNITED STATES OF AMERICA\nIn the\nU. S. GEREMINED\nCourt\nDISTRICT OF MAS CACHUSETIS\nfirth\nSS :\nDISTRICI OF MASCACHUSETTS\n3. (dalpla Brinas\naged 25 years,\noccupation Grocery clerk\ndo declare afferm on oath that my personal\ndescription is: Color white complexion darh height 5 feet 3 inches,\ntoad\nweight 13 t pounds, color of hair black , color of eyes brown\nSeventh\nto organized gou\nother visible distinctive marks\nnone\nintention to beco\n; I was born in Tuchym Curland\nparticularly to\nRusser\nthe 15th day of march\nto reside perman\non\nanno\nEighth. ,\nDomini I 882 I now reside at / 3 Kennard\nVinth\nI emigrated to the United States of America from4 Southas storteny\nthe\nthis petition, sir\non the vessel St Paul\n[Iftheallen arrived otberwise than by vessel the character of conveyance or name of transportation company should be given. ;\nmy last\nof,this petition\nresidence was South africa Kemberley\nTenth.\nforeign\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nsaid-prittion was\nprince, potentate, state, or sovereignty, and particularly to Micilas E\nAttached he\nEmperar\nof which I am now a\ncitizon\nsubject\nI\nmy affidanit and\narrived at the port of\nnew York\nin the\nState\nTerritory-of\nnew York\non or about the 10th day\nDistrict\nDeclaration\nof august\n,\nanno Domini I 907 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:\nSTAT\nCau\nSo HELP ME GOD.\n+ adalphand\nThe aforesar\n(Original signature of declarant.)\ncontents thereof:\nSubscribed\nand affirmed sworn to before me this tenth\nand 8\nday of September anno Domini 1907\nZ\nLb.Tucker,\nJuh\nDeputy\nU, S. CIRCUIT\nbeint\nGlerk of the\nCourt.\nDISTRICT OF MASSACHUSETTS\nmadiately\npation"
}