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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
no
none
The full name of the person shown on my steamship ticket was
My mother's maiden name was
Elesianae Harper
My maiden name was (if woman) mary E Lemier
My post-office address is
100 HowardSt, new London, Conn
The came to was at
ticket on which I this country bought Provier (City) du Law (Couptry) Ganada
1st cabin
If arrival by ship: Name of steamship line was
2d cabin
3d cabin
I arrived as (passenger, stowaway, seaman, member of crew, or otherwise)
passenger
(State whieh)
I traveled on (an immigration visa, a passport, a permit)
none
(State which)
no
I paid
head tax at
, on
(State amount)
(City)
(State or country)
(Month)
(Day)
(Year)
I was examined by immigration officers at
none
At that time I intended to remain (permanently, temporarily, for visit, in transit)
Visit
(State which)
The person in the United States I was coming was
to Desire (Give namo in full)
Leveque
The place in the United States I was going to was
Berlin nite
The names of some of the persons or passengers I traveled with were
Don't remember
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
Moxico
from which I entered the United States was Rivire der Poul
(c) On
June
22
1914
(d) The place where was examined at was
(Month) I for (Day) admission the United (Year) States border no
(e) If not state and the circumstances of
examined, why, give your entry no examination
Canada
(f) The place in
Mexico
where I bought my railroad ticket to come to the United States was
Reviers du Last Plue
GOVERNMENT PRANTING OFFICE
1
8
(OVER)
mary (Signature michand of applicant)
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
- 33db1864e8567590
- 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\nhave not used another name in this country than that given at the beginning\nof this form. If so, it was\nI used that name because\nno\nnone\nThe full name of the person shown on my steamship ticket was\nMy mother's maiden name was\nElesianae Harper\nMy maiden name was (if woman) mary E Lemier\nMy post-office address is\n100 HowardSt, new London, Conn\nThe came to was at\nticket on which I this country bought Provier (City) du Law (Couptry) Ganada\n1st cabin\nIf arrival by ship: Name of steamship line was\n2d cabin\n3d cabin\nI arrived as (passenger, stowaway, seaman, member of crew, or otherwise)\npassenger\n(State whieh)\nI traveled on (an immigration visa, a passport, a permit)\nnone\n(State which)\nno\nI paid\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 officers at\nnone\nAt that time I intended to remain (permanently, temporarily, for visit, in transit)\nVisit\n(State which)\nThe person in the United States I was coming was\nto Desire (Give namo in full)\nLeveque\nThe place in the United States I was going to was\nBerlin nite\nThe names of some of the persons or passengers I traveled with were\nDon't remember\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\nMoxico\nfrom which I entered the United States was Rivire der Poul\n(c) On\nJune\n22\n1914\n(d) The place where was examined at was\n(Month) I for (Day) admission the United (Year) States border no\n(e) If not state and the circumstances of\nexamined, why, give your entry no examination\nCanada\n(f) The place in\nMexico\nwhere I bought my railroad ticket to come to the United States was\nReviers du Last Plue\nGOVERNMENT PRANTING OFFICE\n1\n8\n(OVER)\nmary (Signature michand of applicant)"
}