1. Name:
a. What is your full name?
2. Age:
a. How old are you?
3. Sex:
a. What is your sex? (male or female)
4. Marital Status:
a. What is your marital status? (single, married, widowed or divorced)
5. Nationality:
a. What is your nationality?
6. Occupation:
a. What is your occupation?
7. Last Permanent Residence:
a. What was your last permanent residence?
8. Destination in the U.S.:
a. Where are you headed in the United States?
9. Name and Address of Closest Relative or Friend in the U.S.:
a. Who is your closest relative or friend in the U.S.?
b. What is their address?
10. Amount of Money Brought to the U.S.:
a. How much money have you brought with you to the U.S.?
11. Whether You Have Ever Been in Prison or a Poorhouse:
a. Have you ever been in prison?
b. Have you ever been in a poorhouse?
12. Whether You Are an Anarchist:
a. Are you an anarchist?
13. Whether You Are a Polygamist:
a. Are you a polygamist?