2

2.

Have you been registered and fingerprinted in accordance with the provisions of the Alien RegistrationCARD TAKE BY IMMIGRATION OFFICERSHIP AT LANDING

Act, 1940?

YES

( Yes or no)

If so, what is your alien registration number?

3.( a) At what address in the United States are you living at present? Scattergood Hostel ST.

West Branch .

( Town or city)

( PLEASE PRINT)( Street and number)

Iowa

( State)

( b) What is your present permanent residence address( either in the United States or in a foreign country)?

( If you have no permanent residence write" None.")

NONE

( PLEASE PRINT)( Street and number)

( Town or city)

( Province or state)

( c) What is your present post- office address in the United States ?

West Branch

( Town or city)

( Country)

Scattergood Hostel

( Street and number)

Iowa

( State)

4.( a) What is your race?( Check in appropriate square.) White: Negro: Chinese : Japanese :

Other:

( Give race)

( b) In the following indicated spaces state your sex, height, weight, color of hair and eyes, and visibledistinctive marks, if any: Male: Female Height 5 feet 5 inches; weight 180 lb.;

GRAY hair; BROWN

eyes;

distinctive marks

( Color)

( Color)

NONE

5.( a) When were you born?

MARCH( Month)

15( Day)

1879( Year)

( b) Where were you born? In or near the town or city of LANDSBERG- ON THE WARTHE in the prov-

PRUSSIA

ince or state of

in the country of

6.( a) Of what country are you a citizen or subject? DEPRIVED

( Country )

GERMANY

OF GERMAN CITIZENSHIP

( b) How did you acquire your present citizenship?( Check in appropriate square.) By birth: Natural-

ization: Otherwise.

( If you check" Otherwise," explain your answer in this space)

( c) If you are a naturalized citizen of any country, state the place and date of your naturalization:

NONE( Place)

( Month)

( Day)

( Year)

16-19234