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[[left margin]] ANNUAL ADDRESS REPORT FORM I-53 [[/left margin]] BEFORE YOU FILL OUT THIS CARD CAREFULLY READ INSTRUCTIONS OF THE OTHER SIDE 1 MY ALIEN REGISTRATION LETTER AND NUMBER IS -> A V T L OTHER | 1107950 (CIRCLE WHICHEVER ABOVE LETTER APPEARS BEFORE YOUR NUMBER) (IF 'OTHER'-SPECIFY) | (PRINT YOUR REGISTRATION NUMBER) 2 MY FULL, COMPLETE NAME IS--> Kuniyoshi| Yasuo| (LAST NAME) (FIRST NAME) (MIDDLE NAME) 3 I REGISTERED UNDER THE NAME OF -> Kuniyoshi| Yasuo| (LAST NAME) (FIRST NAME) (MIDDLE NAME) 4 MY RESIDENCE IN THE UNITED STATES IS -> 118 Waverly Place| New York 11 | N.Y.| (YOUR STREET ADDRESS OR RURAL ROUTE) (CITY) (STATE) 5 I AM IN THE UNITED STATES AS A -> PERMANENT RESIDENT VISITOR STUDENT OTHER|I AM A CITZEN OR SUBJECT OF THE COUNTRY OF: [[x]] 1 2 3 4 OTHER |-> Japan (CHECK WHICHEVER BOX INDICATES YOUR STATUS IN U.S.) (IF 'OTHER' - SPECIFY) 6 THE COUNTRY IN WHICH I WAS BORN AND THE DATE OF MY BIRTH WAS -> Japan(COUNTRY OF BIRTH) | BIRTHDATE -> Sept.(MONTH) | 1(DAY) | 1893(YEAR) | I AM A: MALE x 1 FEMALE 2 7 THE PLACE WHERE I ENTERED THE UNITED STATES AND THE DATE OF MY ENTRY WAS -> Seattle, Wash. (PLACE OF ENTRY INTO U.S.) | DATE ENTERED U.S. -> August (MONTH) | 3 (DAY) | 1906 (YEAR) 8 I CERTIFY THAT ALL ABOVE STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE -> Yasuo Kuniyoshi (SIGNATURE OF ALIEN, PARENT, OR GUARDIAN) JAN 5/53 (WRITE IN THE DATE ON WHICH YOU SIGN THIS CARD)
Transcription Notes:
Don't know how to input boxes.