File No. 811.111/733e

The Acting Secretary of State to the Diplomatic and Consular Officers

No. 535
General Instructions
Consular

To the American diplomatic and consular officers:

Gentlemen: There is annexed a copy of the “Joint order requiring passports and certain information from aliens who desire to enter the United States during the war,” which has been signed by the Secretary of State and the Secretary of Labor under date of July 26, 1917. A copy of the “Declaration of alien about to depart for the United States” is also enclosed.

Your special attention is directed to the provisions of the above-mentioned order and declaration, which you should study with the greatest care and with which you are instructed to comply strictly. For the proper defense of the United States in the present war it is imperative that complete information be furnished as to each proposed traveler or immigrant to the United States, in order that it may be possible to control travel and prevent the admission of those whose attitude might be inimical and whose presence might constitute a danger. At the same time it is equally important to advise prospective immigrants to the United States of the exclusion provisions of Section 3 of the Immigration Act of February 5, 1917, of which you were informed in General Instruction (Consular) No. 514, and to give them due warning when it appears that they are liable to be excluded thereunder. Diplomatic and consular officers should understand that in matters relating solely to immigration their functions are advisory only and not administrative. They have no power to exclude a prospective immigrant because he appears [Page 795] to be excludible under the law just mentioned. The decision in each case rests with the immigration authorities in the United States.

For your guidance in the carrying out of this order, and also in connection with the verification of passports for American citizens proceeding to the United States, the following rules are set forth.

installation of system

(1) Translation and publication of requirements.—A translation or translations of Section 3 of the Immigration Act of February 5. 1917 (see General Instruction, Consular, No. 514), and of the enclosed form of declaration (see par. 19), into the language or languages of the country to which you are assigned will be made immediately by the mission, or, in the absence of a mission, by the principal consular officer in the country. Printed copies of these translations should be forwarded to all American consular officers in such country for distribution upon request among prospective immigrants.

The translations should be published as far as possible in local newspapers, particularly those read by persons of the immigrant classes, and copies in large print should be posted in all consular offices, including consular agencies, although consular agents should not take declarations or make visas.

The newspapers and proper officials in the country or district, except in Canada, should be notified that all persons about to journey to the United States must carry passports and have them verified or visaed by American consular officers in the country from which they start upon their journey, at least two weeks before the time of their departure, as well as in the country from which they embark, or from which they enter the United States if they come by land.

The cost of such necessary advertisements and notices may be included in the contingent expenses of the various offices.

(2) Distribution of declaration forms.—The form of declaration enclosed should be translated as stated above, and such translation printed in lines parallel with English text upon sheets the size of the enclosed form, and in similar type, by the mission or principal consular office and furnished in sufficient numbers immediately to all consular offices, except consular agencies. These forms, printed both in English and the language of the country, are the forms to be used by the aliens.

(3) Department to be notified.—Upon publication of notice as above and distribution of necessary declaration forms, the mission or principal consular office should notify the Department by telegraph of that fact and that compliance is being made with the requirements of this circular regarding declaration and visa.

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aliens’ passports

(4) Who must carry passports.—Every alien leaving a foreign country for the United States (except persons starting from Canada) with the purpose of entering or passing through or touching at any port of the United States, is required to present a valid passport or other official document in the nature of a passport, establishing his or her identity and nationality, having attached a signed and certified photograph of the bearer.

Such passport may include a wife, female children under 21 years of age, or male children under 16 years, a photograph of each being attached. Boys over 16 years must have separate passports.

(5) Visa by consuls.—Each passport of an alien must be visaed by an American consul in the country from which the holder first starts upon his trip with intention to proceed to the United States, and also in the country from which he embarks for the United States, or, if he enters the United States by land, in the country through which he enters. In case the country from which he starts is not the one to which he owes allegiance, his passport must first be visaed by a diplomatic or consular officer therein of his own country.

(6) Form of visa.—The form of visa shall be as follows:

Seen

No.

Bearer is to depart for the United States of America between _ _ _ _ _ _ _ _ _ and _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _,
Consul

Date
[Seal]

A rubber stamp may be used for this purpose and the cost thereof included in contingent expense accounts.

(7) When application for visa should be made.—Applications for visa of passports should be made at least two weeks before intended departure from the country from which the journey is to begin. It may be necessary at first for exceptions to be made to this requirement, but when sufficient time has elapsed for the regulations to become generally known this requirement should be strictly enforced, except in cases of unusual emergency.

(8) Numbering of visas.—Each office should number the visas of foreign passports serially, beginning January 1 of each year.

. . . . . . . . . . . . . .

(10) Fee.—No fee is to be collected for the visaing of foreign passports.

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(11) Records.—Visas of foreign passports should not be entered in the consular fee book. The file of declarations (see par. 18) in the consulate will be considered as sufficient record.

When the passport of an alien is visaed in a country other than that in which the declaration is made, the perforated slip at the foot of the declaration form (see par. 18) should be filled in as indicated and retained in the office which makes the second visa. These slips should be filed alphabetically and will be sufficient record of such supplemental visas.

(12) Refusal to visa.— Passports must not be visaed for German subjects or subjects of countries between which and the United States diplomatic relations have been severed, unless special authorization is granted by the Department.

Visas for other aliens should not be refused unless there is evidence supporting a suspicion that the bearer is proceeding to the United States for an enemy purpose. If proof exists, or circumstances strongly indicate, that he has such purpose and therefore should not be admitted to the United States, a visa should be refused and the Department informed, by telegraph if necessary. In such cases the declarant should not be furnished with a copy of his declaration (see par. 18), but that copy should be forwarded to the Department.

If there is doubt as to the bearer of a foreign passport, but no tangible proof that he may be dangerous to the United States, the passport may be visaed and report made to the Department, by telegraph if necessary. It is important to note, however, that where there is actual evidence that an alien is inimical to the United States, or has connections with an enemy agent, the officer taking the declaration must decline to visa the passport.

Foreign passports should not be visaed in the country of embarkation, or from which the bearer enters the United States, when he has not procured a visa from the proper American official in the country from which he started on his journey.

(13) Reports to colleagues.—Diplomatic and consular officers in the country from which a person proposing to go to the United States starts upon his journey should report each doubtful or suspicious case to the diplomatic and principal consular officers stationed in the country from which such person intends to sail or enter the United States.

(14) Aliens to be informed of regulations.—In order to prevent or avoid, so far as possible, the hardship and dangers involved in deportation under present conditions, the diplomatic and consular officer to whom a passport is presented for visa shall ascertain to the fullest extent practicable whether the holder is a member of any one [Page 798] of the classes excluded from the United States by provisions of Section 3 of the Immigration Act of February 5, 1917. If in the judgment of such official the alien is a member of such a class, he shall so advise the alien, informing him of the serious risk he is assuming in attempting to enter the United States, but if the alien, nevertheless, insists on proceeding, the officer shall visa the passport, if it is valid, and if there is no evidence that the alien is inimical to the United States, but shall place upon the alien’s declaration the notation, “Advised that he will probably be rejected and deported.” In such a case the consul making the notation shall write upon the declaration, to be sent to the proper immigration official in the United States, a statement of his reasons for making it.

aliens’ declarations

(15) Who must make declarations.—Every alien carrying a passport, except one starting from Canada, and except a duly accredited official, must make a written declaration in accordance with the requirements of the annexed order before the American consular officer who visaes his passport in the foreign country from which he starts on his trip to the United States. Such declaration must be executed in triplicate and sworn to before the consular officer, and photographs of the bearer and of persons accompanying him must be affixed to each copy under consular seal. A wife or minor child who does not expect to reside with the husband or father in the United States must have a separate declaration.

(16) Disposition of declarations.—One copy of each declaration must be filed in the issuing office, one forwarded immediately to the Commissioner of Immigration or the inspector at the port of entry into the United States, and one copy pasted or attached by a clip to declarant’s passport, in such a manner that it may be readily detached upon his departure from the United States.

The last-mentioned copy must be presented with the passport to the official at the port of entry, who examines passports, and to the immigration official who inspects the holder, and to such other officials in the United States as may be authorized to inspect such documents.

(17) Where made.—The declaration must be made before an American consular officer in the country from which the alien starts on his, journey to the United States. (See par. 15.)

(18) Contents of declaration.—The declaration shall set forth the bearer’s name, occupation, and nationality, and the names and places of birth of the members of his immediate family who accompany him, and also state the facts called for in the joint order annexed and in the enclosed declaration form.

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The perforated slip at the foot of the declaration form is to be filled in, detached and filed as the office record of visas of foreign passports made in the country of departure when the latter is not the country in which the declaration was made.

If the country of departure is the same as that from which the alien starts for the United States, the officer who makes the visa and before whom the declaration is made should detach and destroy the slip.

(19) Form and preparation of declaration.—In the blank form for the declaration the first six questions should be printed on the first page, and in offices where large numbers of visas are necessary, particularly in consulates at ports of departure, it may be necessary to require the declarants to have the first page filled in outside the consulate, in steamship offices or elsewhere, before applicants apply for visas.

Item 7 as to purpose of visit, and items 8 and 9, the statements to the effect that the immigrant understands the exclusion provisions of the law and is prepared to risk deportation should he prove ineligible for admission to the United States, should be answered in the consular office.

Where a case is doubtful and it is manifestly desirable to obtain more information in regard to the applicant, the officer taking the declaration will be expected to make all necessary inquiries.

(20) Remarks.—Provision is made in the declaration form for remarks by the officer taking the same. In immigration cases, if the prospective immigrant has been advised that he will probably be rejected and deported, the reason for such advice should be stated under “Remarks.” If the declarant is suspected but visa is not refused, because of lack of evidence, the grounds for such suspicion should be stated fully under “Remarks,” but only in the copies of the form sent to the immigration office and retained for filing in the issuing office.

In cases of persons who have never been in the United States, it will suffice in question 4 of the declaration for the word “not” to be inserted, so as to make the sentence read: “I have not previously resided in the United States.”

(21) Date of sailing and name of steamer.—It is probable that in countries other than those from which a person going to the United States embarks the exact date of sailing or the name of the vessel may not be known. In such cases it will suffice to give the approximate date of sailing and the name of the steamship line by which the alien proposes to travel.

(22) Amendment to declaration.—If after arrival at the port of departure there is a change in the date of sailing or name of vessel on which the alien proposes to sail, the officer visaing the passport [Page 800] may amend the declaration which the intended passenger carries by affixing thereon with a rubber stamp the statement:

Amendment to Declaration No. _ _ _ _ _ _

Made at_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Sailing on vessel and date named impossible.

Amended for steamship sailing about_ _ _ _.

(23) Numbering declarations.—Each declaration should be numbered serially, a new series beginning on the first day of each calendar year.

. . . . . . . . . . . . . .

(25) Fee.—No fee is to be collected for or in connection with the execution of this declaration.

(26) Records.—Copies of declarations of aliens whose passports are visaed should be indexed upon cards and filed according to number and date. Declarations of those whose passports are refused visa should be marked “visa refused” and kept in a separate alphabetically arranged file. No entry in the record books need be made of any of these declarations.

(27) Consular agents not to take declarations or issue visas.—Consular agents, unless especially directed by the Department of State in specific instances, are not authorized to take the declarations of aliens or to visa foreign passports.

(28) Section 6 Certificates.—The method now in force in regard to the issuance and authentication of Section 6 Certificates for Chinese coming to the United States is considered as sufficient in such cases and this instruction does not change such method.

american passports

(29) Verification by consuls.—While consular officers visa by the use of the word “seen” passports of aliens coming to the United States, they are required to verify by the use of the word “good” passports of Americans. Such passports should be examined before verification to determine whether they are genuine. If there is reason to suspect the holder of an American passport of disloyalty to this country, consular officers should investigate and report the facts to the Department.

(30) Place of verification.—Passports of Americans should be verified by a diplomatic or consular officer in the country where the journey to the United States is begun and also by such officer in the country (though not necessarily at the seaport), from which the American sails or, if he comes by land, in the country from which he enters the United States.

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(31) Numbering.—Each verification of an American passport should be numbered serially, a new series beginning on the first day of each calendar year.

. . . . . . . . . . . . . .

(33) Fee.—No fee is to be collected for verifying American passports.

(34) Records.—Verifications of American passports should be recorded as usual and reported as required in paragraph 164, Consular Regulations.

(35) General.—Telegrams of inquiry or warning concerning immigration cases should not be sent in cipher, unless the information contained therein is such that it makes this clearly necessary.

Especially qualified officials having a knowledge of the immigration laws and regulations will be detailed to the consular offices at immigrant centers and important ports of departure. These officials will be subject to the supervision and orders of the principal officer at the place to which they are assigned. In particular they are expected to assist in the explanation of Section 3 of the Immigration Act of February 5, 1917, and in investigations of persons en route to the United States.

Consular officers in carrying out this order will keep in close touch with the missions which will have general supervision of this work in their respective countries, and constant, close and harmonious cooperation between the missions and the consular offices is expected by the Department.

Missions in some countries may, if necessary, be specially authorized by the Department to take declarations and to visa or verify passports.

The Department relies upon the earnest and efficient assistance of diplomatic and consular officers in enforcing the Joint Order, and expects that they will use due diligence and exercise a wise discretion. Inasmuch as it is desirable for the prompt and effective working of this arrangement that as many cases as possible should be disposed of without reference to the Department, consular officers should in the first instance refer cases as to which they are in doubt to the consul general in the country or to the principal consulate at which an immigration official may be stationed, and in case of necessity to the mission.

Suggestions, as well as necessary inquiries, concerning the proper observance and application of the annexed order and regulations, are, of course, welcomed by the Department.

Despatches relating to this subject should be in triplicate.

I am [etc.]

Frank L. Polk
[Page 802]
[Enclosure 1]

Joint Order of the Department of State and the Department of Labor Requiring Passports and Certain Information from Aliens Who Desire to Enter the United States during the War

To diplomatic and consular officers and immigration officers of the United States, steamship and railway lines of the United States and other countries, aliens, and all others concerned:

After due publication of this order in foreign countries every person leaving a foreign country for the United States (except persons starting from Canada) with the purpose of entering, passing through, or touching at a port of the United States shall be required, before he is permitted to enter the United States, to present a valid passport, or other official document in the nature of a passport, satisfactorily establishing his identity and nationality, with a signed and certified photograph of the bearer attached. A wife, or female child under 21 years of age, or male child under 16 years of age, may be included in the passport of the husband or parent, but a photograph of each must be attached to such passport. Each male child 16 years of age or over must carry a separate passport: Provided, That, where it is shown to the satisfaction of the Secretary of Labor that passports are denied to seamen to prevent their coming ashore in American ports for purposes of reshipment, the Secretary of Labor may authorize the admission of such seamen without the presentation of passports.

Each passport of an alien must be visaed by an American consulate, or the diplomatic mission if specially authorized, in the country from which the holder starts upon his trip to the United States. If the country from which he starts on his trip to the United States is not the country to which he owes allegiance, he must also have his passport visaed by a diplomatic or consular officer therein of his own country. Moreover, every alien coming to the United States must have his passport, or document in the nature of a passport, visaed by a consular officer of the United States in the country from which he embarks for the United States, or, if he comes by land, from which he enters the United States. The form of such visa should read as follows: “Seen. Number _ _ _ _ _ _ _. The bearer is to depart for the United States of America between (date) and (date).”

For the purpose of ascertaining the identity, nationality, and objects of aliens entering the United States (except those starting from Canada), each alien, except a duly accredited official, must, after due publication of this order, furnish to the American diplomatic or consular officer who visaes his passport, in the foreign country [Page 803] from which he starts on his trip to the United States, and to the American authorities at the port of entry or elsewhere in the United States, a written declaration setting forth the bearer’s name, occupation, and nationality and the names and places of birth of the members of his immediate family who accompany him, and stating the following facts: (1) the date and place of the bearer’s birth; (2) the nationality and race of his father and mother; (3) the place of the bearer’s last foreign residence and the other places, if any, where he has resided within the past five years; (4) if he has ever been in this country, the dates and objects of his visits and the places and addresses where he resided or sojourned; (5) the date set for his departure for the United States, the port of embarkation, and the name of the ship on which he is to sail, if he goes by water; (6) names and addresses of persons acquainted with the applicant in the country from which he starts and in the United States; (7) the expected duration and object of his proposed visit to this country, the documentary or other proofs of such object submitted, and the place or places in the United States where he expects to sojourn or reside; (8) that the bearer knows and understands the provisions of Section 3 of the Immigration Act of February 5, 1917, excluding certain classes of aliens from the United States, and is certain that he does not fall within any of such classes; (9) that the bearer understands that if, on arrival at a port of the United States, he is found to be a member of a class excluded by said immigration law, he will be deported if practicable, or, if for any reason deportation should be found to be impracticable, will be held in detention indefinitely in an immigration station or other place of confinement, and that he is, with full understanding thereof, assuming all risks involved in a possible return trip in consequence of being rejected under such law. A wife or minor child who does not expect to reside with the husband or father in this country will be required to carry a separate declaration.

Each declaration must be affirmed or sworn to before a consular officer, or a diplomatic officer of the United States, if specially authorized, and signed in triplicate, and a photograph of the declarant must be attached to each copy with an impression of the official seal. The declaration must be made at least two weeks before the date of intended departure, except in cases of extraordinary emergency. One copy of the declaration must be filed in the embassy, legation, or consulate by which the passport is first visaed, one copy forwarded immediately to the Commissioner of Immigration or inspector in charge at the port of entry by which the declarant expects to enter the United States, and one copy fastened to the passport of the declarant, in such a way that it may be removed upon his departure from the United States. The copy last mentioned must [Page 804] be presented with the passport to the official at the port of entry into this country who examines passports, and to the immigration official who inspects the holder, and to such other officials in the United States as may be authorized to inspect such documents.

No fee shall be collected by diplomatic or consular officers of the United States for or in connection with the execution of such declaration or the visaing of passports.

No American embassy, legation, or consulate shall visa a passport of an alien enemy of the United States to enable him to enter this country unless special authorization of this Government has been previously obtained.

In order to prevent or avoid so far as possible the hardships and dangers involved in deportation under present conditions, a diplomatic or consular officer to whom a passport is presented for visa shall ascertain to the fullest extent practicable whether the holder is a member of any one of the classes excluded from the United States by the provisions of Section 3 of the Immigration Act of February 5, 1917, and if in the judgment of such official the alien is a member of any such excluded class he shall so advise the alien, informing him of the serious risk he is taking in attempting to enter the United States, and, if the alien nevertheless insists on proceeding, shall visa the passport if it is valid, but shall place upon the alien’s declaration the notation: “Advised that he will probably be rejected and deported.” In such case the consul making the notation shall write upon the copy of the declaration to be sent to the proper immigration official in the United States a statement of his reasons for making it.

Aliens “likely to become a public charge,” from whatsoever cause such likelihood may arise, are excluded by Section 3 of the Immigration Act (S. Rep. No. 352, 64th Cong., 1st sess.). Unless, during the present state of war, aliens applying for admission present evidence by which their identity and nationality are positively proved, such aliens, if they enter the United States, are liable to be taken into custody as enemies and thereby become public charges. Therefore, immigration officials will exclude from the United States any alien who may apply for admission and not be in possession of a passport or other official document establishing his identity and nationality, visaed in the manner specified in this order, and will cause such alien to be returned to the country whence he came, at the expense of the transportation company involved: Provided, however, That such exclusion shall not be made in the cases of alien seamen arriving in ports of the United States, unless such seamen apply for permanent admission to this country, or unless it is necessary to require such papers in order to ascertain whether alien seamen are enemies of the United States; nor in the cases of aliens entering temporarily [Page 805] from contiguous foreign territory to follow agricultural pursuits, in accordance with the terms of Department of Labor circular of May 23, 1917, and the supplements thereto. Alien seamen not provided with passports or other official documents showing their identity and nationality may be detained until they receive passports from the consular representatives of the countries whose nationality they claim. Any alien who enters the United States in violation of this order shall be arrested, in substantial conformity with rule 22 of the Immigration Rules, with a view to his deportation to the country whence he came, and his detention under proper restrictions until such deportation can be effected.

  • Frank L. Polk
    Acting Secretary of State
  • W. B. Wilson
    Secretary of Labor
[Enclosure 2]

Declaration of Alien about to Depart for the United States (Form No. 228; Established July, 1917)

(See General Instruction No. 535)

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Title of office) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Place) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Date)

I,_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, (Name of declarant) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, (Occupation) a citizen or subject of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, (Name of country) bearer of passport No. _ _ _ _ _ _ _ _ _ _, dated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, issued by _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, (Name of office) am about to go to the United States, accompanied by

Wife, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, (Full name) born at _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Sons under 16 years of age as follows:

_ _ _ _ _ _ _ _ _, (Name) born at _ _ _ _ _ _ _ _ _ _ _ _ _ _, _ _ _ _ _ _ _ _ (Date)

_ _ _ _ _ _ _ _, born at _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, _ _ _ _ _ _ _ _ _

And daughters under 21 years of age as follows:

_ _ _ _ _ _ _ _ _ _, (Name) born at _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, _ _ _ _ _ _ _(Date)

_ _ _ _ _ _ _ _ _ _ _ _ _ _, born at_ _ _ _ _ _ _ _ _ _ _ _ _ _ _, _ _ _ _ _ _ _

1. I was born at _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, (Place) on _ _ _ _ _ _ _ _ _ _ _ _ _ _ _; (Date)

2. My father was a citizen or subject of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ of the _ _ _ _ _ _ _ _ _ _ _ _ _ _ race; my mother was born a citizen or subject of _ _ _ _ _ _ _ _ _ _ _ _ _ of the _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ race;

[Page 806]

3. (a) I last resided at _ _ _ _ _ _ _ _ _ _ _ _ _ _, (Place) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Address) on _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Dates)

(b) I have resided in or visited the following countries within the past five years:

_ _ _ _ _ _ _ _ _ _ _ _ _ _; (places, addresses, and dates)

4. I have _ _ _ _ _ _ _ _ _ _ _ _ previously resided in the United States as follows:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ (Dates) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Place and address)

_ _ _ _ _ _ _ _ _ _ _ _ _ _ (Object of residence) _ _ _ _ _ _ _ _ _ _ _;

5. I intend to depart for the United States on the date, from the port, and on the steamship as follows:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Date) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Port) _ _ _ _ _ _ _ _ _ _ _ _ _ _; (Steamship)

6. I name the following, with addresses, as references:

(a)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (In the country from which declarant starts)
(b)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (In the United States)

7. I expect to go to the United States for _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Object of visit) as shown by _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Documents or other proofs of object) to reside at _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ for a period of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _; (City, street, and number)

8. I have informed myself of the provisions of Section 3, Immigration Act of February 5, 1917, and am convinced that I am eligible for admission into the United States thereunder;

9. (a) I realize that, if I am one of a class prohibited by law from admission into the United States, I will be deported or detained in confinement in the United States, and

(b) I am prepared to assume the risk of deportation and of a compulsory return trip in case of my rejection at an American port.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Signature of declarant)

Subscribed and sworn to before me this _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ day of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, (Month and year) _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Official signature)

N. B.—The taking of this declaration and visaing of the bearer’s passport give no assurance that the bearer is not excludable from the United States under Section 3 of the Immigration Act of February 5, 1917. The decision in each case must be made by the immigration authorities in the United States.

Remarks by official taking declaration:

(Photograph)

[Page 807]

Slip to be filled in, detached, and filed by office making supplemental visa if country of departure for United States is different from that in which declaration is made. No. of visa _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ (Place) _ _ _ _ _ _ _ _ _ _ _ _ (Date)

Declaration of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Accompanied by _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Wife and number of minor children)

Issued by American consular officer at _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

On _ _ _ _ _ _ _ _ _ _ _ _
(Date)