Hebrew Immigrant Aid Society, Boston, Massachusetts

              Form N-600
(Old 2400)
TJ.  S. DEPARTMENT OF JUSTICE
Immigration and Naturalization Service at
(Edition of 7-1-43)	
APPLICATION FOR CERTIFICATE OF DERIVATIVE CITIZENSHIP
INCLUDING STATEMENT CONCERNING ARRIVAL OF APPLICANT
For use in searching records of arrival:
RECORDS EXAMINED RECORD FOUND
Place       Date .
Card index    Name   	
Index books             	
Manifests     Manner      	
Marital status   	
(Signature of pereon making aearoh)
TO THE APPLICANT: Do not write above this line.    Read carefully and follow the instructions on page 4 hereof
(This form must be completely filled out—preferably on a typewriter).
Take or mail this to
DISTRICT DIRECTOR OF IMMIGRATION AND NATURALIZATION
nor chean hereby
(City or town) (County) (State)
apply to the Commissioner of Immigration and Naturalization for a certificate showing that I am a derivative citizen of the
Urited States of America.
In support of my application I enclose three photographs of myself each of which I have signed, and United States postal
money order No.  in the sum of $5, made payable to the order of the "Commissioner of Immigration and
Naturalization, Washington, D. C in payment for this application, and submit the following facts:
(1)  I arrived in the United,States through the port of 
under the name of 
(Month) (Day) (Year)
on the vessel 
(If otherwise than by vessel. ..how manner of arrival) 
(If arrival was through arrived at the port of Mexico
on on the vessel  
(Month) . (Day) (Year)
(2) I have  been absent from the United States as follows:
(Datea of departure and return, porta of entry, and namee of veaacle or other n
I have been absent at any other time. ,
(3) I have used another name in this country than that given above.    (If so) It was   	
I used that name because
(4) The full name of the person shown on my steamship ticket was 
(5) I was born in 
(6) My father's full name is/was
(7) My mother's maiden name was 
(8) (If a married woman) My maiden name was 	
(9) My last foreign residence was 
(City or town)
(10)  The place where I took the ship or train which landed me in the United States was
(11) The ticket on which I came to this country was bought at
(12) (If arrival by ship) Name of steamship line was
first, second, or third cabin      I arrived as a passenger, stowaway, seaman,
member of crew, or otherwise 
(13) I traveled on (an immigration visa, a passport, or permit to reenter)
(14) I paid $ feft head tax at
(City or town)
(15) I was  examined by United States immigration officers at
(16) (If not examined, state why, and give the circumstances of your entry
State which
(State or oountry)
(17) The person in the United States to whom I was coming was 
(18) The place in the United States to which I was going was
(19) The names of some of the passengers or other persons I traveled with and their relationship to me, if any, are 
mother,  three brothers