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No. 1911
TRIPLICATE
[To the person making
the Declasation)
STATES OF
Department of Commerce and Tabur
BUREAU OF IMMIGRATION AND NATURALIZATION
DIVISION OF NATURALIZATION
DECLARATION OF INTENTION
(Invalid for all purposes seven years after the date hereof)
STATE OF CALIFO!
of
In the
SUPERIOR Court
SS :
of THE STATE or CALIFORNIA,
IN AND FOR Los ANOELES COUNTY,
3.
Basil proloff
aged
28 years,
occupation Interpreter
do
declare on oath
affiem
that my personal
description is: Color white
complexion Jank , height 5 feet 6 inches,
weight 150 pounds, color of hair Brown color of eyes Brown
other visible distinctive marks
none
;
I was born in
fatta
ausira
on the
28th
day of
January
, anno
Domini I 881. ; I now reside at 24312 a Antriou ex Las Anyclis bad
I emigrated to the United States of America from neloon Canada
on the vessel
Greax northen a R.
(If the allen arrived otherwise than by vessel, the character of conveyance or name of transportation company should be given.]
; my last
foreign residence was
nelson
Canada
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreigo
prince, potentate, state, or sovereignty, and particularly to nicholas
II
Empiron of Russia
, of which I am now a
subject
arrived at the port of
Boundry
in the
State
Tessitary of
District
mashington
on or
about the 21 are day
of Reyand
anno Domini 907 I am not an anarchist: I am not
polygamist nor a believer in the practice of polygamy: and it is my intention in good faiti
to become a citizen of the United States of America and to permanently reside therein
So HELP ME GOD.
Basil (Orlginal signature of declarant-)
Subscribed and sworn to before me this
affirmed
[SEAL. ]
day of number , anno Domini
C. G.
COUNTY AND EX
THE IN ALID FOB THE cou
Glash of ther LOS ANGELER,
grocky
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"ocrText": "No. 1911\nTRIPLICATE\n[To the person making\nthe Declasation)\nSTATES OF\nDepartment of Commerce and Tabur\nBUREAU OF IMMIGRATION AND NATURALIZATION\nDIVISION OF NATURALIZATION\nDECLARATION OF INTENTION\n(Invalid for all purposes seven years after the date hereof)\nSTATE OF CALIFO!\nof\nIn the\nSUPERIOR Court\nSS :\nof THE STATE or CALIFORNIA,\nIN AND FOR Los ANOELES COUNTY,\n3.\nBasil proloff\naged\n28 years,\noccupation Interpreter\ndo\ndeclare on oath\naffiem\nthat my personal\ndescription is: Color white\ncomplexion Jank , height 5 feet 6 inches,\nweight 150 pounds, color of hair Brown color of eyes Brown\nother visible distinctive marks\nnone\n;\nI was born in\nfatta\nausira\non the\n28th\nday of\nJanuary\n, anno\nDomini I 881. ; I now reside at 24312 a Antriou ex Las Anyclis bad\nI emigrated to the United States of America from neloon Canada\non the vessel\nGreax northen a R.\n(If the allen arrived otherwise than by vessel, the character of conveyance or name of transportation company should be given.]\n; my last\nforeign residence was\nnelson\nCanada\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreigo\nprince, potentate, state, or sovereignty, and particularly to nicholas\nII\nEmpiron of Russia\n, of which I am now a\nsubject\narrived at the port of\nBoundry\nin the\nState\nTessitary of\nDistrict\nmashington\non or\nabout the 21 are day\nof Reyand\nanno Domini 907 I am not an anarchist: I am not\npolygamist nor a believer in the practice of polygamy: and it is my intention in good faiti\nto become a citizen of the United States of America and to permanently reside therein\nSo HELP ME GOD.\nBasil (Orlginal signature of declarant-)\nSubscribed and sworn to before me this\naffirmed\n[SEAL. ]\nday of number , anno Domini\nC. G.\nCOUNTY AND EX\nTHE IN ALID FOB THE cou\nGlash of ther LOS ANGELER,\ngrocky"
}