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1st cabin
If by ship: Name of steamship line was
2d
3d cabin
I (passenger, stowaway, seaman, member of crew, otherwise) (State which)
arrived as or
passanger
I traveled on (an immigration visa, a passport, a permit) Otate which)
passport
I paid
head tax at
, on
(State amount)
(City)
(State or comntry)
(Month)
(Day)
(Year)
I was examined by immigration officers at crew M. 4.
yah,
At time I intended to remain for in transit)
that (permanently, temporarily visit, (State which)
The person in the United States I was coming to was
Koun
Stepurko
period
The
place in the United States I was going to was (Gf ve name foll)
The names of some of the persons or passengers I traveled with were
My last place of foreign
residence was Metianchi, Russia
(City OF town)
(Country)
{
wife
is many
She
I am
married. The name of my
was born at
Valua, Rursia
husband said resides at Lebanm, Carlos He
, and now
I am now a subject of and intend to renounce
allegiance to Present Great Russia
(Write name and title of sovereign and country of which now a subject;
or, if citizen
I arrived
newyork
at of a the Republic, United write name States of Republic Immigration only) port of Echostlant (City or town) New 1911 fook
,
(State territory)
or
on June (Give exact 4, 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)
f
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
where I bought my railroad ticket to come to the United States was
Mexico
Sergey. e14-8 Kosteukewich Sem Kos (Signature torich of applicant)
GOVERNHENT PRINTING office
(OVER)
Page data
- Page
- 328
- Source index
- 0
- Type
- photo
- Media ID
- 4fb0ce4c174db112
- 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": "1st cabin\nIf by ship: Name of steamship line was\n2d\n3d cabin\nI (passenger, stowaway, seaman, member of crew, otherwise) (State which)\narrived as or\npassanger\nI traveled on (an immigration visa, a passport, a permit) Otate which)\npassport\nI paid\nhead tax at\n, on\n(State amount)\n(City)\n(State or comntry)\n(Month)\n(Day)\n(Year)\nI was examined by immigration officers at crew M. 4.\nyah,\nAt time I intended to remain for in transit)\nthat (permanently, temporarily visit, (State which)\nThe person in the United States I was coming to was\nKoun\nStepurko\nperiod\nThe\nplace in the United States I was going to was (Gf ve name foll)\nThe names of some of the persons or passengers I traveled with were\nMy last place of foreign\nresidence was Metianchi, Russia\n(City OF town)\n(Country)\n{\nwife\nis many\nShe\nI am\nmarried. The name of my\nwas born at\nValua, Rursia\nhusband said resides at Lebanm, Carlos He\n, and now\nI am now a subject of and intend to renounce\nallegiance to Present Great Russia\n(Write name and title of sovereign and country of which now a subject;\nor, if citizen\nI arrived\nnewyork\nat of a the Republic, United write name States of Republic Immigration only) port of Echostlant (City or town) New 1911 fook\n,\n(State territory)\nor\non June (Give exact 4, 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)\nf\nCanada\n(b) The place in\n}\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\nwhere I bought my railroad ticket to come to the United States was\nMexico\nSergey. e14-8 Kosteukewich Sem Kos (Signature torich of applicant)\nGOVERNHENT PRINTING office\n(OVER)"
}