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I have not used another name in this country than that given at the beginning of this form. If so, it was
I used that name because
The full name of the person shown on my steamship ticket was
Luiz Pereira
My mother's maiden name was
Felecidode Pereina
My maiden name was (if woman)
My post-office address is
Bor245 water Sheet Storing ton . & Conn
The ticket on which I came to this country was bought at
Leria
Portugal
(City)
(Country)
If arrival by ship: Name of steamship line was
Fabre Line
Ist cabin
{
2d cabin
3d cabin
I arrived as (passenger, stowaway, seaman, member of crew, or otherwise)
Passenger
(State which)
I traveled on (an immigration visa, a passport, a permit)
Passport
(State which)
I paid
no
head tax at
, on
(State amount)
(City)
(State or country)
(Month)
(Day)
(Year)
I was examined by immigration at
officers "Lisboa
At (permanently, temporarily, visit, transit)
that time I intended to remain for in
Premanently
(State which)
The in the United States I amtonio Silva
person was coming to was
(Give name in full)
The place in the United States I was going to was
New Bedford
The names some persons or passengers
of of the I traveled with were blandic santos
Emidio Pinto
ADDITIONAL FACTS TO BE GIVEN IF ALIEN CAME FROM OR THROUGH CANADA OR MEXICO:
(a) The place in Canada where I landed was
, on
(Month)
(Day)
(Year)
Canada
(b) The place in
from which I entered the United States was
Mexico
(c) On
(Month)
(Day)
(Year)
(d) The place where I was examined for admission at the United States border was
(e) If not examined, state why, and give the circumstances of your entry
Canada
(f) The place in
Mexico
where I bought my railroad ticket to come to the United States was
Luiz Percisa of
GOVEDNMENT PRENTING OFFICE
14-
(OVER)
(Signature applicant)
Page data
- Page
- 1256
- Source index
- 0
- Type
- photo
- Media ID
- bef9441cf715ff26
- Size
- unknown
Document data
- ID
- 159596813
- 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": "I have not used another name in this country than that given at the beginning of this form. If so, it was\nI used that name because\nThe full name of the person shown on my steamship ticket was\nLuiz Pereira\nMy mother's maiden name was\nFelecidode Pereina\nMy maiden name was (if woman)\nMy post-office address is\nBor245 water Sheet Storing ton . & Conn\nThe ticket on which I came to this country was bought at\nLeria\nPortugal\n(City)\n(Country)\nIf arrival by ship: Name of steamship line was\nFabre Line\nIst cabin\n{\n2d cabin\n3d cabin\nI arrived as (passenger, stowaway, seaman, member of crew, or otherwise)\nPassenger\n(State which)\nI traveled on (an immigration visa, a passport, a permit)\nPassport\n(State which)\nI paid\nno\nhead tax at\n, on\n(State amount)\n(City)\n(State or country)\n(Month)\n(Day)\n(Year)\nI was examined by immigration at\nofficers \"Lisboa\nAt (permanently, temporarily, visit, transit)\nthat time I intended to remain for in\nPremanently\n(State which)\nThe in the United States I amtonio Silva\nperson was coming to was\n(Give name in full)\nThe place in the United States I was going to was\nNew Bedford\nThe names some persons or passengers\nof of the I traveled with were blandic santos\nEmidio Pinto\nADDITIONAL FACTS TO BE GIVEN IF ALIEN CAME FROM OR THROUGH CANADA OR MEXICO:\n(a) The place in Canada where I landed was\n, on\n(Month)\n(Day)\n(Year)\nCanada\n(b) The place in\nfrom which I entered the United States was\nMexico\n(c) On\n(Month)\n(Day)\n(Year)\n(d) The place where I was examined for admission at the United States border was\n(e) If not examined, state why, and give the circumstances of your entry\nCanada\n(f) The place in\nMexico\nwhere I bought my railroad ticket to come to the United States was\nLuiz Percisa of\nGOVEDNMENT PRENTING OFFICE\n14-\n(OVER)\n(Signature applicant)"
}