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The Chung Collection

Petition for a certificate of Canadian citizenship by a natural-born Canadian citizen [Government of Canada] 1900

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Full Text

 Form J
CANADA
THE CANADIAN CITIZENSHIP ACT
PETITION FOR A CERTIFICATE OF
CANADIAN CITIZENSHIP BY
A NATURAL-BORN CANADIAN CITIZEN
To the Secretary of State of Canada:
The Petition of	
of the of in
the County of , in the Province of	
respectfully sheweth:
1. My name in full is	
2. My occupation is	
3. My address in full is	
4. I was born on the day of 19	
at  of 	
in
5. I am a natural-born Canadian citizen:
(a) by birth in Canada;
(b) by birth outside Canada on the following grounds:
,   „ subjects   r
6. My parents were —r-. of..
J r citizens
7. I came to Canada from *	
and arrived at the port of on the	
day of 19  on the vessel	
or by the Railway.
* If the Petitioner waa born in Canada he is not required to complete paragrapth 6 or 7.
10M-11-46 Form J
8. (a)  My name above set out is that under which I have been known at all times.
(b) I came to the Dominion of Canada under the name of	
 and I am now known under the name above set forth.
9. I am married.   My
wife's
-.—; jj- name is
husband s
She
He
She
He
was born at.
now resides at..
Place and date of marriage..
10. I have children under the age of twenty-one years and their names, residences and
dates and places of birth are as follows:
(1) resides at	
born  at 	
(2) resides at '.	
born  at 	
(3) resides at	
born  at	
(4) resides at	
born  at 	
(5) resides at	
born  at 	
(6) resides at	
born  at 	
(7) '. resides at	
born  at 	
Form J
11. Your petitioner, therefore, humbly prays that a certificate of citizenship be issued to him.
12. The following are correct particulars of my description for endorsement on the certificate of
citizenship:
Age years.   Height feet inches
Colour   Complexion  	
Colour of eyes Colour of hair	
Visible distinguishing marks	
That the statements made in the said petition are true in substance and in fact.
SWORN before me at the	
of   	
in the County of	
and Province of	
this day of.
A.D. 19	
Petitioner's signature
Notary Public
Commissioner
Justice of the Peace.

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