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I have yes used another name this country than that given the beginning of this form. in at If so, it was I used that name because it was laser to stanley Jourshiet The full name of the person shown on my steamship ticket was stenislous Tomczak My mother's maiden name was Hedwig Rebacrak My maiden name was (if woman) My post-office address is The ticket on which I came to this country was bought at Hanlung (City) (Country) If arrival by ship: Name of steamship line was Hambary Pluercies line 1st cabin 2d cabin 3dacin 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) permit too top (State which) I paid 37,00 (State amount) head tax at Handug (City) , on (State or country) (Month) (Day) (Year) I examined by immigration officers at New yours was At that time I intended to remain (permanently, temporarily, for visit, in transit) (State which) Permanently The person in the United States I was coming to was my lirfe y (Give namein full) The was was place in the United States I going to Central Come, Village The names of some of the persons or passengers I traveled with were 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 The place in Mexico where I bought my railroad ticket to come to the United States was GOVERNMENT PIMINTING OFFION 14-8 (OVER) (Signature of applicant)

Page data

Page
1215
Source index
0
Type
photo
Media ID
2a3301a67a4578d0
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 yes used another name this country than that given the beginning of this form.\nin at If so, it was\nI used that name because it was laser to\nstanley Jourshiet\nThe full name of the person shown on my steamship ticket was stenislous Tomczak\nMy mother's maiden name was Hedwig Rebacrak\nMy maiden name was (if woman)\nMy post-office address is\nThe ticket on which I came to this country was bought at\nHanlung\n(City)\n(Country)\nIf arrival by ship: Name of steamship line was Hambary Pluercies line\n1st cabin\n2d cabin\n3dacin\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)\npermit\ntoo top\n(State which)\nI paid 37,00 (State amount) head tax at Handug (City)\n, on\n(State or country)\n(Month)\n(Day)\n(Year)\nI examined by immigration officers at New yours\nwas\nAt\nthat time I intended to remain (permanently, temporarily, for visit, in transit) (State which)\nPermanently\nThe person in the United States I was coming to was my lirfe y (Give namein full)\nThe was was\nplace in the United States I going to Central Come,\nVillage\nThe names of some of the persons or passengers I traveled with were\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\nThe place in\nMexico\nwhere I bought my railroad ticket to come to the United States was\nGOVERNMENT PIMINTING OFFION 14-8\n(OVER)\n(Signature of applicant)"
}