Dane CCC R201400

Record Type: Declaration

Family Name: Forsmo

Given Name: Kristian Johan Dinesen

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

Given Name - Alternate:

Address: Black Earth, Wis. (R.F.D.)

Vol/Page (Enter V-PG or Filed YYYY): 4-223

Title/Location of Court: Circuit Court, Dane

Place of Birth: Kjellman, Norway

Date of Birth: May 4, 1876

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 #: