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EXHIBIT IX

(c) Form A-2214. Boston.

No. 1. APPLICATION FOR A CERTIFICATE OF ARRIVAL AND PRELIMINARY FORM FOR PETITION

FOR CITIZENSHIP, UNITED STATES DEPARTMENT OF LABOB, NATURALIZATION SERVICE

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(Signature of person making search) Use Form 160 in issuing certificate of arrival on this application.

To the applicant: Do not write above this line. Read carefully and follow the instructions on last page hereof.

Take or mail this to District Director of Naturalization, Young's Hotel, Boston, Mass.

Date--

19_ I hereby apply for a certificate of arrival showing my lawful entry for permanent residence in the United States of America lor filing with my petition for citizenship to the--

---court at--(Name of court)

(City or town) (State) and herein submit a statement of facts to be used as a basis for such petition.

There are inclosed with this application, as required by law and the instructions herein, my declaration of intention (first paper), my original immigrant identification card No.

(see statement No. 10), two photographs of me each of which I have signed, and postal money order No. in the sum of $5, made payable to the order of the "Commissioner of Naturalization, Washington, D. C.," in payment for the certificate of my arrival. I arrived in the United States at-----

(City or town)

(State) under the name of...

(Month) (Day) (Year) on the vessel..

(If otherwise than by vessel, show manner of arrival)

on.

ADDITIONAL FACTS TO AID IN LOCATING A RECORD OF MY ARRIVAL

1. I have

used another name in this country than that given above. (If so) It was.

I used that name because 2. The full name of the person shown on my steamship ticket was. 3. I was born in--

on (City or town) (Country)

(Month) (Day) (Year) 4. My mother's maiden name was. 5. (If a married woman) My maiden name was.6. My last foreign residence was..

(City or town)

(Country) The place where I took the ship or train which landed me in the United States was---(City or town)

(Country) 7. The ticket on which I came to this country was bought at

(City) (Country) 8. (If arrival by ship) name of steamship line was_ first, second, or third cabin

I arrived as a pas

(State which)
senger, stowaway, seaman, member of crew, or otherwise----

(State which, giving particulars) 9. I traveled on (an immigration visa, a passport, or permit to reenter)

(State which) 10. My original immigrant identification card No.

is not attached because

11. I paid $.

head tax at

(City or town)

(State or county)

on

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(Day) (Year)
examined by United States immigration officers at--

(City or town) (State or county) 13. (If not examined, state why, and give the circumstances of your entry) 14. The person in the United States to whom I was coming was----15. The place in the United States to which I was going was--, 16. The names of some of the passengers or other persons I traveled with

are_I have set forth below my answers to the following questions asked of me: 17. Have you been absent from the United States since the date of your arrival

as stated on page 1 of this form ?If so, state month and year you left

; month and year you returned... To what country did you go?

For what reason? Is this the only time you have been out of the United States?

If not, give particulars as to other absences.18. In what places in the United States have you resided ? From-

to.. (City or town) (State)

(Month) (Year) (Month) (Year) From...

to. (City or town) (State)

(Month) (Year) (Month) (Year) From-

to.. (City or town) (State)

(Month) (Year) (Month) (Year) 19. What were the names and addresses of your employers during the five years

immediately prior to the date of this statement?

(Employer's na mre)

(Date)

(Number and street)

(City)

(State)

(Employer's na mre) (Date) (Number and street) (City) (State) (Employer's name) (Date) (Number and street) (City)

(State) 20. Do you understand the principles of government of the United States? 21. Do you fully believe in the form of government of the United States?-22. Are you ready to answer questions as to the principles and form of govern

ment of the United States?What hare you done to prepare yourself for an examination on the Govern

ment of the United States?. 23. Have you read the following oath of allegiance?

I hereby declare, on oath, that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince, potentate, state, or sovereignty, and particularly to

of whom (which) I have heretofore been a subject (or citizen) ; that I will support and defend the Constitution and laws of the United States of America against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and that I take this obligation freely without any mental reservation or purpose of evasion: So HELP ME GOD.

Are you willing to take this oath in becoming a citizen? 24. If necessary, are you willing to take up arms in defense of this country?-Did you claim exemption from the draft during the World War because you

were an alien ?--Did you surrender your declaration (first paper) at that time? 25. If not now married, have you ever been married ?--- Are you divorced?

Are you a believer in the practice of polygamy?26. Are you a believer in anarchy?

Do you belong to or are you associated with any organization which teaches or advocates anarchy or At what places ?(6) In what place in the United States did you meet for the first time your second witness named on the opposite page--

the overthrow of existing government in this country ?-27. Have you ever been an inmate of an insane asylum ?28. Have you ever been dependent upon public charity ?. 29. Have you ever been arrested or charged with violation of any law of the United States or State or any city ordinance or traffic regulation ?

If so, give full particulars-30. (a) In what place in the United States did you meet for the first time your first witness named on the opposite page---

(City or town) (State) How often did you see this witness each month during the five years

just before the date of this statement ?-

(City or town) (State) How often did you see this witness each month during the five years

just before the date of this statement ?

At what places?----I certify that all the statements made by me in this application and form are true to the best of my knowledge and belief

(Signature of applicant)

(Address at which applicant receives mail)

No.--

STATEMENT OF FACTS TO BE USED IN FILING MY PETITION FOR CITIZENSHIP

(Mr. My name is Mrs.

Miss) (Full true name, without abbreviation, and any other name which has been used, must

appear here) 1. My present residence is.

(Number and street) (City or town) (County) (State) 2. My occupation is_3. I was born in--

con_ (City or town) (County)

(Month) (Day) (Year) My race is

(See page 4 4. I declared my intention to become a citizen (first paper) on-

(Month) in the----

--Court of.. (Day) (Year) at---

(City or town) (State) 5. I am

-_married. The name of my wife or husband is.----We were married on..

(Month) (Day) (Year) at--(City or town

(State or country) She or he was born at..

on.
(City or town) (State or country)

(Month)
Larrived in the United States----
(Day) (Month)

(City or town)
on---

-for permanent residence, and now (Month) (Day) (Year) resides at---

-; was.... (City or town)

(State or country) naturalized on..

at. (Month) (Day) (Year) (City or town) (County) (State) and certificate No-

issued. I have---- ---children, whose names, dates and places of birth, and

places of residence are as follows:
Name
Date and place of birth

Now residing at

6. My last foreign residence was--

(City or town)

(Country) The place where I took the ship or train which landed be in the United States was-(City or town)

(Country) 7. The foreign country of which I am now a subject or citizen is_

--speak English. 9. I have resided continuously in the United States since..

8. I can

(Month)

(Day)

(Year)

I have resided continuously in the county where I now live since----

(Month)

(Day)

(Year) 10. I have --previously made petition for citizenship (second paper). If so, it was No-----

made in the----

(Name of court)
Court at-
(City or town) (State)

(Month) (Day) (Year) and was not granted because.

OD

(If you wish to have your name changed, give full name you desire_

(Give names, occupations, and addresses of two citizens you expect to bring

with you as witnesses when you appear for examination to file your petition. These witnesses must have personal knowledge of your resi, dence in the county at least, and of your character and other qualifica

tions. A foreign-born witness must bring proof of his citizenship.)
(1st)--
(Name)

(Occupation)
residing at.
I first met this witness on.-

(Month)

(Day)

(Year)
(20)---
(Name)

(Occupation)
Residing at-
I first met this witness on..

(Month)

(Day)

(Year) I certify that the above statement of facts has been read by me and that the statement is true to the best of my knowledge and belief.

(Signature of applicant)

(Address at which applicant receives mail)

INSTRUCTIONS TO THE APPLICANT (Pages 1, 2, and 3 of this form must be completely filled out, preferably on a typewriter)

Immigrant identification card.—Every alien who entered the United States for permanent residence on the basis of an immigration visa on or after July 1, 1928, should be in possession of an immigrant identification card bearing a number in red ink. If you arrived on or after the above date, you must attach such card to this application, inserting the number thereof in the appropriate blank space on the first page of this form. Your identification card will be returned to you, after it has served its purpose. If you arrived on or after July 1, 1928, and you do not have an immigrant identification card, either because it is lost or destroyed, or you did not receive such card, you should state the facts in Statement No. 10 on the first page.

Photographs.-You are required to send with this application two photographs of yourself taken within thirty days of the date of this application. These photographs must be 212 by 212 inches in size, must not be pasted on a card or mounted in any other way, must be on thin paper, have a light background, and clearly show a front view of your face without hat. Snapshots, group or full-length portraits will not be accepted. Both of these photographs must be signed by you on the margin and not on the face or the clothing.

Money order.—Unless specifically excepted herein, you must secure a United States postal money order in the sum of $5, payable to the order of the “Commissioner of Naturalization, Washington, D. C.” This money order, which is in payment for the issuance of a certificate of your arrival in the United States must be attached to this application when you send or take it to the naturalization officer named on the first page of this form. You are not required to send a money order with this application if your declaration of intention (first paper) is dated on or after July 1, 1929, or if you are petitioning for citizenship under a provision of the naturalization law which exempts you from the requirement for a declaration of intention and you arrived in the United States for permanent residence prior to June 29, 1906.

Date of your arrival.-If you do not know the exact date of your arrival in the United States, or the name of the vessel or port, and you can not secure this informaion by consulting your family or friends who came over with you, give the facts of your arrival as you remember them in the appropriate blank spaces on the first page of this form. If you have a passport, ship's card, or baggage labels, they may help you to answer these questions.

Raoe and nationality. In furnishing information as to your race in Statement No. 3, page 3, “race" is to be determined from the original stock or blood of your ancestors and the language you speak, as distinguished from "nationality," which means the country of which you are a citizen or subject. For instance, a person may be of French blood or stock but owe allegiance to Great Britain. In that case "race” would be French and “nationality" British. For your information there follows a partial list of races or peoples: African (black). Greek.

Ruthenian (Russniak). Albanian. Hebrew.

Scandinavian (NorweArmenian. Herzegovinian.

gians, Danes, and Belgian. Irish.

Swedes).
Bohemian.
Italian (North).

Scotch.
Bosnian.
Italian (South).

Servian.
Bulgarian.
Japanese.

Slovak.
Chinese.
Korean,

Slovenian.
Croatian.
Latvian.

Spanish.
Cuban.
Lithuanian.

Spanish American.
Dalmatian.
Hagyar.

Swiss.
Dutch.
Mexican.

Syrian.
East Indian.
Montenegrin.

Turkish,
English.
Moravian.

Ukrainian.
Filipino.
Pacific Islander.

Welsh.
Finnish.
Polish.

West Indian (other than
Flemish.
Portuguese.

Cuban.) French.

Rumanian. German.

Russian. The term “ Cuban” refers to the Cuban people (not Negroes); “West Indian” refers to the people of the West Indies other than either Cubans or Negroes; “African (black)” refers to the African Negro, whether coming from Cuba or other islands of the West Indies, North or South America, Europe, or Africa. Any alien with admixture of blood of the African Negro will be classified under this heading. “ Italian (North)” refers to people who are native to the basin of the River Po in northern Italy (i. e., Departments of Piedmont, Lombardy, Venetia, and Emelia) and their descendants, regardless of place of last foreign residence. “ Italian (South)” refers to people who are native to that portion of Italy south of the basin of the River Po (i. e., Departments of Liguria, Tuscany, the Marches, Umbria, Rome, the Abruzzi and Molise, Campania, Apulia, Basilicata, Calabria, Sicily, and Sardinia) and their descendants, regardless of place of last foreign residence.

RESULT OF EXAMINATION
(To the applicant: Do not write on these lines)

Examiner

EXHIBIT X

State constitutions with provisions exempting from military duty persons

whose conscientious scruples forbid them to bear arms

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