Dane CCC R102866

Record Type: Declaration

Family Name: Bloom

Given Name: Issack

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

Given Name - Alternate:

Address: 810 Mound St. Madison, Wis.

Vol/Page (V-PG or Filed YYYY): 5-75

Title/Location of Court: Circuit Court, Dane

Place of Birth: Tyncourty, Minsk, Russia

Date of Birth: Oct. 13, 1870

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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 #: