Dane CCC R203005

Record Type: Declaration

Family Name: Grimdstad

Given Name: Amund

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

Given Name - Alternate: Amund

Address: 702 S. Forest St. Madison, Wis.

Vol/Page (Enter V-PG or Filed YYYY): 11 P 17

Title/Location of Court: Circuit Court, Dane

Place of Birth: Bergen, Norway

Date of Birth: May 29, 1880

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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 #: