cy PASSPORT ISSUED
je bearer to proceed
OO) ATA
(Pons No. 177—Consuran.)
NATURALIZED,
7 us
226.
Lebatey
States, hereby apply to the American.
Fee for Passport, - - - snoo
Fee for administering oath
for a passport for myself, accompanied by my wie
children, a8 follOWS! en horn at _
on the ——_——day of ner and
I solemnly oe) that I was born at Eba> on or about :
the_73— day of, ___, 1962; that T ee to the United States, sailing }
on board the _, from PC ree > a
out the day of =~ 1668. 7,
abow » 1669; that 1 resided SV years, uninter-
raptedly, in the United States, from LEIE to (P03, a Meee -
1.0 Det bic —
that I was naturalized as a citizen of the United States before the TEE De
eg oeleatlin Des luce ag Vevue 1 — 108 the 264 yy)
ofl Coegqese——— Wes, as shown by the accompanying Certificate of Natusglization; i
that Ida the bearer of Passport No. LEC, issued by 4 Case. Levehe
on the day of. 1709 , which is returned herewith; that
Tam the idedtical person referred to in said certificate and passport; that Iam domiciled in the
United States, my permanent residence therein being at M4 J Cte, in the State
Mew York, __, where 1 follow the occupation of naw ghey
last kA phe United States on the ~ day of Vprreceebied igoz Yon Foard
ese eerie tn el heogags nf iy
2
of Sees 1fto ; that I have resided in. 4. since
Ve -day of 402 _____, 1970 ; that I am now temporarily resifiing at
lant. JO. 4; and that T intend to return to the United Stated within
af tas) __wieh a purpose of residing and performing the duties of citizenshigg therein.
T have not applied for a United States passport else
‘where and been refirsed.
I desire the passport for the purpose of Macatee Ae, Levedew Mowry
OATH OF ALLEGIANCE.
Further, I do solemnly swear that Iwill support and defend the Constitution of the United
States 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. z
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ate
Lea Geta ieee
Stature: