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I have NEVER 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 was
ticket MICHAL LEWIC.
My mother's maiden name was ANNIE SAMOIL
My maiden name was (if woman)
My post-office address is R. F. D- Montoille. CoNN.
The ticket on which I came to country was
this bought at BREMEN
(City)
(Country)
termany
If arrival Name of line was NORTH Fermanley.0.
1st cabin
by ship: steamship
2d cabin
3ROFABIN
3d cabin
I arrived as (passenger, stowaway, seaman, crew, or
member of otherwise) PASSENGER
(State which)
I traveled on (an immigration visa, a passport, a permit) Rassport
(State which)
I paid
head tax at Nohezotax,
, on
(State amount)
(City)
(State or country)
(Month) (Day) (Year)
I was examined by immigration officers at ELLIS ISLAND. N.Y.
At
that time I intended to remain (permanently, temporarily, for visit, in transit)
PERMANENTLY
(State which)
The person in the United States I was coming to was John YANOV5KI. (Give name in full)
The place in the United States I going to was JERSEY City N.T. U.S.A.
was
The names of some of the persons or passengers I traveled with were - Paul HORESKO-
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
"
Allickored Leure
GOVERNMENT PRINTING OFFICE
(OVER)
(Signature of applicant)
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
- c098d5f8592880a7
- 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": "₹\nI have NEVER 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 was\nticket MICHAL LEWIC.\nMy mother's maiden name was ANNIE SAMOIL\nMy maiden name was (if woman)\nMy post-office address is R. F. D- Montoille. CoNN.\nThe ticket on which I came to country was\nthis bought at BREMEN\n(City)\n(Country)\ntermany\nIf arrival Name of line was NORTH Fermanley.0.\n1st cabin\nby ship: steamship\n2d cabin\n3ROFABIN\n3d cabin\nI arrived as (passenger, stowaway, seaman, crew, or\nmember of otherwise) PASSENGER\n(State which)\nI traveled on (an immigration visa, a passport, a permit) Rassport\n(State which)\nI paid\nhead tax at Nohezotax,\n, on\n(State amount)\n(City)\n(State or country)\n(Month) (Day) (Year)\nI was examined by immigration officers at ELLIS ISLAND. N.Y.\nAt\nthat time I intended to remain (permanently, temporarily, for visit, in transit)\nPERMANENTLY\n(State which)\nThe person in the United States I was coming to was John YANOV5KI. (Give name in full)\nThe place in the United States I going to was JERSEY City N.T. U.S.A.\nwas\nThe names of some of the persons or passengers I traveled with were - Paul HORESKO-\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\n\"\nAllickored Leure\nGOVERNMENT PRINTING OFFICE\n(OVER)\n(Signature of applicant)"
}