Passport ID:                    

Court/Consulate Location:       
Passport Type:                  
Application Number:             
Oath Date:                      




Name:                           
Immigrant ID:                   OLMP-12JUN1913-3-C33-0027 MGHL-16JUN1922-2-US6-0001 CONS-08DEC1922-2-UT12-0026 

Age:                             years 
Birth Date:                     
Birth Place:                    

Occupation:                     
Height:                         
Eye Color / Hair Color:          / 

Residence Address:              

Naturalization Date / Location / Court:
                                 /  / 



Other Relationship:             

Name:                           
Immigrant ID:                   

Occupation:                     

Witness Name / Occupation / Residence / Time Known Applicant:
                                 /  /  / 

Comments:
emigrated to USA 16 or 17 years ago, resided in USA 7 years / bearer of passport 153960 issued 3-Jan-1920