This Sheet Is For

Ship manifest extraction form

Surname:______From List or Manifest at Port of Arrival

Ship: ______Manifest Page no.: ______Line:______

Sailing from ______Date: ______

Arriving at ______Date: ______

1 Line Number Person #1 Person #2 Person #3 Person #4 on List

Family 2 Name in Full Name Given Name 3 Age Years

Months 4

6 Married/SingleCalling/Occup ation

7 Able to: Read

Write 8

9 NationalityRace or People

Last Perm. 10 Country Residence City/Town 11 Name and address of nearest Final 12 relative/friend State inDestination country whence Alien City/Town 13 came. Line Number 14 on List Ticket to final 15 destination? Who paid 16 Havepassage? $50? If 17 notEver how in US much?before? Year or If yes: period Where? 18 Joining a relative/friend? 19 Who and Ever in prison, 20 where? asylum, etc? 21 A polygamist?

22 AnWhether Anarchist? 23 Mental and 24 Physical healthDeformed/crip pled? Nature 25 &Height cause Feet

Inches 26

Complexion 27 Color of Hair

Eyes 28 Marks of Identification 29 Place of birth Country City/Town

Transcribed by: ______

Transcription date: ______

Title of microfilm publication: ______

Publisher: ______

Microfilm roll # ______NARA pub.number: ______

Page No:______

Exact spelling of the primary name as indexed: ______