Issued _____, 18___.
No.____.
I, William Lassonne, a naturalized and loyal citizen of the United
States, hereby apply to the legation of the United States at St.
Petersburg for a passport for myself.
I solemnly swear that I was born at Hamburg, Germany, on or about the
15th day of May, 1845; that I emigrated to the United States, sailing on
board the _______ from Hamburg on or about the ________ day of _____,
1862; that I resided six years uninterruptedly in the United States,
from 1862 to 1868, at New York; that I was naturalized as a citizen of
the United States before the _____ court of common pleas for city and
county of New York, at New York, on the 28th day of September, 1868, as
shown by the accompanying certificate of naturalization; that I am the
bearer of passport No. 390,321, issued by Hon. William H. Seward on the
2d day of October, 1868, which is returned herewith; that I am the
identical person referred to in said certificate and passport; that I am
domiciled in the United States, my permanent residence therein being at
_____, in the State of ______, where I follow the occupation of ______,
that I last left the United States on the _____day of October, 1868, on
board the Holsatia, arriving in Hamburg the _____
day of ______, 1868; that I have resided in Moscow, Russia, since the
___ day of ______, 1871; that I am now temporarily residing at Moscow,
and that I intend to return to the United States when able to, with a
purpose of residing and performing the duties of citizenship
therein.
I desire the passport for the purpose of business.
Oath of allegiance.
Further, I do solemnly swear that I will support and defend the
Constitution of the United States against all enemies, foreign and
domestic; that I will bear true faith and allegiance to the same;
that I take this obligation freely, without any mental reservation
or purpose of evasion, so help me God.
William
Lassonne.
Legation of the United States at
St. Petersburg.
Sworn to before
me, this 25th of
day of January, 1893.
George W.
Wurts
,
Secretary of Legation.
Description of applicant.
Age, 48 years; stature, 5 feet 5 inches, Eng.; forehead, low;
eyes, blue; nose, long and sharp; mouth, large; chin, small;
hair, brown; complexion, fair; face, oval.
Identification.
I hereby certify that I know the above-named _______ _______
personally, and know h— to be the identical person referred to
in the within-described certificate of naturalization and that
the facts stated in h— affidavit are true to the best of my
knowledge and belief.
_____ _______,
(Address of witness.)
_______
_____.
