Application for Passport – Naturalized.
No. 8782.
|
W. Reid Gould, Law Blank Publisher and Stationer, 168 Nassau St., N. Y.
Issued July 9/78
|
UNITED STATES OF AMERICA.
State of New York
|
ss.
|
County of New York
|
I, Helen P. Blovatsky do swear that I was born in Russia on or about the 31 day of July 1836 that I am a NATURALIZED AND LOYAL CITIZEN OF THE UNITED STATES, and about to travel abroad; and further, that I am the Identical Person described in the Certificate of Naturalization, afterwards presented.
Sworn to before me, this Eighth day
|
Helen P. Blavatsky
|
of July, 1878
|
Joseph H. Brown
|
Notary Public.
|
Description of Helen P. Blavatsky
|
Age: 41 years.
|
Mouth: Large
|
Stature: 5 feet, 5 inches, Eng.
|
Chin: Round
|
Forehead: High
|
Hair: Brown
|
Eyes: Blue
|
Complexion: Fair
|
Nose: Broad
|
Face: Round
|
|
I, Helen P. Blovatsky do solemnly swear that I will support, protect and defend the Constitution an Government of the United States against all enemies, whether domestic or foreign, and that I will bear true faith, allegiance, and loyalty to the same, any ordinance, resolution or law of any State, Convention or Legislature to the contrary notwithstanding; and further, that I do this with a full determination, pledge and purpose, without any mental reservation or evasion whatsoever; and further, that I will well and faithfully perform all the duties which may be required of me by law.
So help me God.
Sworn to before me, this Eighth day
|
Helen P. Blavatsky
|
of July, 1878
|
Joseph H. Brown
Notary Public N.Y.
... to Helen P. Blovatsky
302.10.47
New York City
|
Five dollars tax, as imposed by law, will be required, in U..S. currency, with each application.
When husband, wife, minor, children and servants expect to travel together, a single passport for the whole will suffice.
Fore any other person in the party a separate passport will be required.
Address Department of State, Passport Bureau., Washington, D. C.
|