Dane CCC R201441

Record Type: Declaration

Family Name: Fossem

Given Name: Nils August

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

Given Name - Alternate:

Address: 330 N. Division St. Stoughton, Wis.

Vol/Page (Enter V-PG or Filed YYYY): 2-228

Title/Location of Court: Circuit Court, Dane

Place of Birth: Bergen, Norway

Date of Birth: July 16, 1880

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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:

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Alien Registration #: