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If by ship: Name of steamship line was
2d 1st cabin cabin
3d cabin
I arrived as (passenger, stowaway seaman, member of crew, or otherwise)
(State which)
I traveled on (an immigration visa, a passport, a permit)
(State which)
I paid
head tax at
, on
(State amount)
(City)
(State or country)
(Month)
(Day)
(Year)
I was examined by immigration officers at
At that time I intended to remain (permanently, temporarily, for visit, in transit)
(State which)
The person in the United States I was coming to was
(Give name in full)
The place in the United States I was going to was
The names of some of the persons or passengers I traveled with were
said
Vilna
Rugsia
My last place of foreign residence was
(City or town)
(Country)
I am not married. The name of my
Sh
is
was
born at
husband
He
and now resides at
,
I
am now a subject of and intend to renounce allegiance to thosstateof (Write name and Russia title of
sovereign and country of which now a subject;
or, if citizen of a Republic, write name of Republic only)
I arrived at the United States Immigration port of
(City or town)
new York
New York
on
December 24, 3005
1905
(State or territory)
(Give exact month, day, and year)
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
Samuel H. Peasen
GOVERNMENT PRENTING OFFICE
e14-8
(Signature of applicant)
(OVER)
Page data
- Page
- 63
- Source index
- 0
- Type
- photo
- Media ID
- 7694bca75b76d1e6
- 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": "If by ship: Name of steamship line was\n2d 1st cabin cabin\n3d cabin\nI arrived as (passenger, stowaway seaman, member of crew, or otherwise)\n(State which)\nI traveled on (an immigration visa, a passport, a permit)\n(State which)\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\nAt that time I intended to remain (permanently, temporarily, for visit, in transit)\n(State which)\nThe person in the United States I was coming to was\n(Give name in full)\nThe place in the United States I was going to was\nThe names of some of the persons or passengers I traveled with were\nsaid\nVilna\nRugsia\nMy last place of foreign residence was\n(City or town)\n(Country)\nI am not married. The name of my\nSh\nis\nwas\nborn at\nhusband\nHe\nand now resides at\n,\nI\nam now a subject of and intend to renounce allegiance to thosstateof (Write name and Russia title of\nsovereign and country of which now a subject;\nor, if citizen of a Republic, write name of Republic only)\nI arrived at the United States Immigration port of\n(City or town)\nnew York\nNew York\non\nDecember 24, 3005\n1905\n(State or territory)\n(Give exact month, day, and year)\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)\n{\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\nSamuel H. Peasen\nGOVERNMENT PRENTING OFFICE\ne14-8\n(Signature of applicant)\n(OVER)"
}