Dane CCC R102467

Record Type: Declaration

Family Name: Berntsen

Given Name: Osvald Marinius

Family Name - Alternate (X- Name at top of card):

Given Name - Alternate:

Address: 312 N. 5th St. Madison, Wisconsin

Vol/Page (V-PG or Filed YYYY): 18-109

Title/Location of Court: Circuit Court, Dane

Place of Birth: Oslo, Norway

Date of Birth: June 7, 1891

Certificate #:

Port of Arrival:

Arrival Date:

Naturalization Date:

Witness 1:

Witness 1 Address:

Witness 2:

Witness 2 Address:

Age:

Date of admission:

Date Certificate Issued:

Petition #:

Alien Registration #: