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Passport ID: Court/Consulate Location: Passport Type: Application Number: Oath Date: Name: Immigrant ID: Age: years Birth Date: Birth Place: Occupation: Height: Eye Color / Hair Color: / Residence Address: Emigrated From (Date): Ship Name: Resided in USA: Naturalization Date / Location / Court: / / Left Country: Other Relationship: Name: Immigrant ID: Occupation: Comments:later emigrated in 1909, lived in USA from 1909 to 1919 / bearer of passport 124635 issued 4-Oct-1919