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citizen of the United States; that I am domiciled in the United States, my permanent residence being at

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...

where I follow the occupa

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that I am about to

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porarily; and that I intend to return to the United States

with the purpose of residing and

performing the duties of citizenship therein.

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; and that I take this obligation freely, without any mental reservation or purpose of evasion: So help me God. Sworn to before me this.....

.day

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I hereby certify that I know the above-named.

personally, and know him to be a native-born citizen of the

United States, and that the facts stated in his affidavit are true

to the best of my knowledge and belief.

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izen of the United States, hereby apply to the Department of State, at Washington, for a passport for myself, accompanied by....

as follows:

born at.

on the

.day of...

18... ; and...

I solemnly swear that I was born at...

on or about the......day of....

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that I emigrated to the United States, sailing on board the

the....day of...

at....

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years, uninterruptedly, in the United States, from...... to

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19. ..., as shown by the accompanying

Certificate of Naturalization; that I am the identical person described in said Certificate; that I am domiciled in the United States, my permanent residence being at....

in the State of

of.....

rily;

...

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where I follow the occupation

; that I am about to go abroad tempora and that I intend to return to the United States...

with the purpose of residing and performing the

duties of citizenship therein.

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; and that I take this obligation freely, without any mental reservation or purpose of evasion: So help me God.

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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.]

Applicant desires passport sent to following address:

Passports issued by the Secretary of State are in the following form:

[SEAL]

UNITED STATES OF AMERICA.

DEPARTMENT OF STATE.

To all to whom these presents shall come, Greeting:

I, the undersigned, Secretary of State of the United States of America, hereby request all whom it may concern to permit ....., a citizen of the United States,

safely and freely to pass, and in case of need to give .... all lawful aid and protection.

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Given under my hand and the seal of the Department of State,

at the city of Washington, the ..... day of

in the year 190...., and of the independence of the United States the one hundred and twenty-eighth.

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PART IV.

EXPATRIATION.

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