Dane CCC R201461

Record Type: Declaration

Family Name: Fosdal

Given Name: Camilla Salmine

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

Given Name - Alternate:

Address: 505 Low Str., Stoughton, Wis.

Vol/Page (Enter V-PG or Filed YYYY): 19-129

Title/Location of Court: Circuit Court, Dane

Place of Birth: Kristiansand, Norway

Date of Birth: 6-6-85

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Arrival Date:

Naturalization Date:

Witness 1:

Witness 1 Address:

Witness 2:

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Age:

Date of admission:

Date Certificate Issued:

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Alien Registration #: