Dane CCC R300032

Record Type: Declaration

Family Name: Grotzman

Given Name: Issay

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

Given Name - Alternate:

Address: 143 S. Hancock St. Madison, Wis.

Vol/Page (Enter V-PG or Filed YYYY): 11 P 274

Title/Location of Court: Circuit Court, Dane

Place of Birth: Temryvk, Kuban, Russia

Date of Birth: Oct. 30, 1892

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 #: