Application for Passport – Naturalized.
No. 8782.
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W. Reid Gould, Law Blank Publisher and Stationer, 168 Nassau St., N. Y.
Issued July 9/78
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UNITED STATES OF AMERICA.
State of New York
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ss.
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County of New York
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I, Helen P. Blavatsky 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
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Helen P. Blavatsky
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of July, 1878
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Joseph H. Brown
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Notary Public.
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Description of Helen P. Blavatsky
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Age: 41 years.
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Mouth: Large
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Stature: 5 feet, 5 inches, Eng.
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Chin: Round
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Forehead: High
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Hair: Brown
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Eyes: Blue
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Complexion: Fair
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Nose: Broad
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Face: Round
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I, Helen P. Blavatsky 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
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Helen P. Blavatsky
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of July, 1878
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Joseph H. Brown
Notary Public N.Y.
... to Helen P. Blavatsky
302.10.47
New York City
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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.
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