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I have used another name in this country than that given at the beginning of this form. If so, it was I used that name because it was wrote followed Antoni Zinewicy Anthony zinavage The full name of the person shown on my steamship ticket was My mother's maiden name was My maiden name was (if woman) My post-office address is The ticket on which I came to this country was bought at Wilkes - Bave Penn (City) (Country) arrival by ship: Name of steamship line was 3rd, class 1st cabin If { 2d 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 new fact At that time I intended to remain (permanently, temporarily, for Visit, in transit) (State which) The was was person in the United States I coming to Cronista Kasrisan The in the United States I Plains Henk (Give name in full) place was going to was The of of the I traveled with mother and Sister names some persons or passengers 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) (b) The place in { Canada 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 GOVERNMENT PRINTING OFFICE 14 8 (OVER) (Signature of applicant)

Page data

Page
475
Source index
0
Type
photo
Media ID
0c015b11328b2f88
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
{
    "id": "159596813",
    "sourceUrl": "https://catalog.archives.gov/id/159596813",
    "contentType": "document",
    "title": "File numbers 4874 - 5509, 1926-1930",
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Document source extras
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    "onlineResources": [
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    "recordType": "description",
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Page context
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    "ocrText": "I have\nused another name in this country than that given at the beginning of this form. If so, it was\nI\nused that name because it was wrote followed\nAntoni Zinewicy Anthony zinavage\nThe full name of the person shown on my steamship ticket was\nMy mother's maiden name was\nMy maiden name was (if woman)\nMy post-office address is\nThe ticket on which I came to this country was bought at\nWilkes - Bave Penn\n(City)\n(Country)\narrival by ship: Name of steamship line was 3rd, class\n1st cabin\nIf\n{\n2d cabin\n3d cabin\n}\nI\narrived 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\nnew\nfact\nAt that time I intended to remain (permanently, temporarily, for Visit, in transit)\n(State which)\nThe was was\nperson in the United States I coming to Cronista\nKasrisan\nThe in the United States I Plains Henk\n(Give name in full)\nplace was going to was\nThe of of the I traveled with mother and Sister\nnames some persons or passengers 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(b) The place in\n{\nCanada\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\nGOVERNMENT PRINTING OFFICE\n14\n8\n(OVER)\n(Signature of applicant)"
}