Dane CCC R102733

Record Type: Petition

Family Name: Bjornstad

Given Name: Amanda Henrietta

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

Given Name - Alternate:

Address: Rt. 4, Madison, Wisconsin

Vol/Page (V-PG or Filed YYYY): Order Book-Page 104

Title/Location of Court: Circuit Court, Dane

Place of Birth: (See other side)

Date of Birth: Nov. 27, 1883

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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 #: