Naturalization ID:              

Court Location:                 
Court Type:                     
Court Description:              

Form Type:                      
Form Number:                    
Form Date:                      


Name:                           
Immigrant ID:                   PANN-22JAN1920-3-5-0024 

Birth Date:                     
Birth Place:                    

Occupation:                     
Marital Status:                 

Height / Weight:                 / 
Eye Color / Hair Color:          / 

Residence Address:              

Last Foreign Residence:         
Emigrated From (Date):          
Arrival Port (Date):            
Ship Name:                      

Declaration Date / Number / Location / Court:
                                 /  /  / 

Marriage Date:                  
Marriage Place:                 



Spouse Name:                    
Spouse Immigrant ID:            LBRT-14MAY1912-3-5-0011 DOMI-02SEP1912-3-E-0001 

Spouse Birth Date:              
Spouse Birth Place:             

Spouse Arrival Port (Date):     

Spouse Naturalization Date / Certificate / Location:
                                 /  / 

Residency Location (Date):      

1st Witness Name / Occupation / Residence:
                                 /  / 

2nd Witness Name / Occupation / Residence:
                                 /  / 

Petition Outcome / Date / Certificate:
                                 /  / 

Comments:
scar over l[eft] eye

Children:

Action	Name	Sex	Birth Date	Birth Place	Residence	Comments	Immigrant ID
	Hedison [Khedishian], Larry	M	1931-09-11	Medford, MA, USA	Medford, MA, USA