Immigrant ID:                 

Ship Name:                    
Origin Date (Port):           
Destination Date (Port):      
Ship Class / List / Number on List:      /  /           <--- Click icon to view others on same ship manifest

Passenger Name:               
Age:                           years  months
Sex / Marital Status / Occupation:       /  / 
Height:                       
Birth Place:                  
Last Residence:               
Other Immigrant IDs:          

Leaving Name:                  (nearest friend or relative in country whence alien came)
Leaving Relationship:         
Leaving Immigrant ID:         
Leaving Location:             

Joining Name:                  (whether going to join a relative or friend)
Joining Relationship:         
Joining Immigrant ID:         
Joining Location:             

Comments:
                              mother of 63/11 / goiter simple