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No.
ITo the Honor
The
First.
Domini
anno Domini
mph.
de
o
1
have
Form 2908
TRIPLICATE
n
2530
U. S. DEPARTMENT OF LABOR
the Decloration)
NATURALIZATION SERVICE
45741
No.
Seventh I
to organized gover
DECLARATION OF INTENTION
intention to beco
particularly to
ET Invalid for all purposes seven years after the date hereof
to reside permaner
Eighth. Iam
United States of America,
In the District Court of the United States,
Minth hai
ss:
Northern District of Ohio,
Cleveland, Ohio.
da
Samel Seess
36
this petition. since
ge,
aged
years,
earpeuter
of this petition.
do declare on oath that my personal
occupation
white
dark
10
Tenth. have
description is: felor
complaxion.
height
feet
inches,
thay
weight
pounds, color of hair
color of eyes
said petition was del
nono
other visible distinctive marks
Derry Irolam
Attached herei
I was born in
10
Januery
567
on the
dav.of
anno Domini I
;
I now reside
together with my aff
7749 Ave; Clev aland
Ohio.
States of America.
at
(Give number, street, and city or town.) MeeseJes, Canada
I emigrated to the United States of America from
C.
Declaration of Intenté
on the vessel
; my last
(If the alien arrived otherwise
should be given.)
NOTR
character of conveyance or name of transportation
foreign residence was
; am
married; the name
of my wife is
: she was born at
State of
and now resides at
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
Coun
prince, potentate, state, or sovereignty, and particularly to
The aforesald per
GEORGE V KING OF GREAT BRITAIN & IREL.AND of whom I am now a subject;
contents thereof; that
Pertal
,
in the
and belief, and that as
I arrived at the port of
M.
State of
on or about the
day
916
anno Domini I
: I am not an anarchist; I am not
a
of
Algan
polygamist nor a believer in the practice of polygamy: and it is my intention in good faith
and
to become a citizen of the United States of America and to permanently reside therein
Krife
So HELP ME GOD.
X samuel Scott
each being severally dul
sa
(Original algnature of declarant.)
immediately preceding th
Subscribed and sworn to before me in the office of the Clerk of said Cour
entitled petition la made
Sopt
at Cleveland, Ohio, this
day of
the said petitioner too,
[SEAL]
D.C.MILLER
anno Domini 19
opinion, to be admitted a
the District Court the United State
Dep reque
By Clerk of Deputy M-un
bleveran
Clerl
Subscribed and
of
Domme
Del
Permanent Or rallroad company, or
(Tifle) Ading
Raw
any other conveyance.
Page data
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- Source index
- 0
- Type
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Document data
- ID
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- Core
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- Type
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DTO data
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Context sent to Scholar
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"ocrText": "No.\nITo the Honor\nThe\nFirst.\nDomini\nanno Domini\nmph.\nde\no\n1\nhave\nForm 2908\nTRIPLICATE\nn\n2530\nU. S. DEPARTMENT OF LABOR\nthe Decloration)\nNATURALIZATION SERVICE\n45741\nNo.\nSeventh I\nto organized gover\nDECLARATION OF INTENTION\nintention to beco\nparticularly to\nET Invalid for all purposes seven years after the date hereof\nto reside permaner\nEighth. Iam\nUnited States of America,\nIn the District Court of the United States,\nMinth hai\nss:\nNorthern District of Ohio,\nCleveland, Ohio.\nda\nSamel Seess\n36\nthis petition. since\nge,\naged\nyears,\nearpeuter\nof this petition.\ndo declare on oath that my personal\noccupation\nwhite\ndark\n10\nTenth. have\ndescription is: felor\ncomplaxion.\nheight\nfeet\ninches,\nthay\nweight\npounds, color of hair\ncolor of eyes\nsaid petition was del\nnono\nother visible distinctive marks\nDerry Irolam\nAttached herei\nI was born in\n10\nJanuery\n567\non the\ndav.of\nanno Domini I\n;\nI now reside\ntogether with my aff\n7749 Ave; Clev aland\nOhio.\nStates of America.\nat\n(Give number, street, and city or town.) MeeseJes, Canada\nI emigrated to the United States of America from\nC.\nDeclaration of Intenté\non the vessel\n; my last\n(If the alien arrived otherwise\nshould be given.)\nNOTR\ncharacter of conveyance or name of transportation\nforeign residence was\n; am\nmarried; the name\nof my wife is\n: she was born at\nState of\nand now resides at\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nCoun\nprince, potentate, state, or sovereignty, and particularly to\nThe aforesald per\nGEORGE V KING OF GREAT BRITAIN & IREL.AND of whom I am now a subject;\ncontents thereof; that\nPertal\n,\nin the\nand belief, and that as\nI arrived at the port of\nM.\nState of\non or about the\nday\n916\nanno Domini I\n: I am not an anarchist; I am not\na\nof\nAlgan\npolygamist nor a believer in the practice of polygamy: and it is my intention in good faith\nand\nto become a citizen of the United States of America and to permanently reside therein\nKrife\nSo HELP ME GOD.\nX samuel Scott\neach being severally dul\nsa\n(Original algnature of declarant.)\nimmediately preceding th\nSubscribed and sworn to before me in the office of the Clerk of said Cour\nentitled petition la made\nSopt\nat Cleveland, Ohio, this\nday of\nthe said petitioner too,\n[SEAL]\nD.C.MILLER\nanno Domini 19\nopinion, to be admitted a\nthe District Court the United State\nDep reque\nBy Clerk of Deputy M-un\nbleveran\nClerl\nSubscribed and\nof\nDomme\nDel\nPermanent Or rallroad company, or\n(Tifle) Ading\nRaw\nany other conveyance."
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