Dane CCC R202519

Record Type: Petition

Family Name: Gjertson

Given Name: Anna M.

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

Given Name - Alternate:

Address: Rt. 2 Stoughton, Wis.

Vol/Page (Enter V-PG or Filed YYYY): Order Book page 115

Title/Location of Court: Circuit Court, Dane

Place of Birth: (see other side)

Date of Birth: Sept. 22, 1888

Certificate #:

Port of Arrival:

Arrival Date:

Naturalization Date:

Witness 1: (over)

Witness 1 Address:

Witness 2:

Witness 2 Address:

Age:

Date of admission:

Date Certificate Issued:

Petition #:

Alien Registration #: