Application Number: 30603
Issued: MAY 18, 1914
United States of America, State of Illinois, County of Cook
I, Katerina Filipek a naturalized and loyal citizen of the United States, do hereby apply to the Department of State at Washington for a passport for myself
(the phrase "accompanied by my wife and minor children as follows" was crossed out)
I solemnly swear
that I was born at Mazalov, Bohemia on or about the 20th day of October 1864;
that my Husband emigrated to the United States, sailing on board the _________ from Bremen on or about the 15th day of May, 1889;
that he resided 24 years, uninterruptedly, in the United States, from 1889 to 1914, at Chicago Ills & Pueblo, Colo.;
that he was naturalized as a citizen of the United States before the Criminal Court of Cook County at Chicago, on the 2nd day of April, 1900, as shown by the accompany [at this point the words Passport 48227 were penciled in] 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 Chicago, in the state of Illinois where I follow the occupation of Merchant;
that I am the Widow of the person described in said Certificate;
that I have resided in the United States, uninterruptedly, for 24 years, from 1889 to Date, at Chicago Ills & Pueblo, Colo.;
that I am domiciled in the United States, my permanent address being at Chicago, in the State of Illinois, where I follow the occupation of Housewife;
that I am about to go abroad temporarily; that I intend to return to the United States within Six Months with the purpose of residing and performing the duties of citizenship therein.
Oath of Allegiance
Furthermore, 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 mental reservation or purpose of evasion: So help me God.
Sworn to before me this 15th day of May, 1914
Katerina Filipek
Charles A. Churau (Notary Public)
Description of Applicant:
Age: 49
Stature: 5 feet 1/2 inches
Forehead: Broad
Eyes: Blue
Nose: Straight
Mouth: Medium
Chin: Round
Hair: Dk Brown
Complexion: Brunette
Face: Round
Identification:
I hereby certify that I know the above named Katerina Filipek personally, and know her to be the widow of the person referred to in the within-described Certificate of Naturalization, and that the facts stated in her affidavit are true to the best of my knowledge.
Charles A. Churau
828 Unity Bldg (address of witness)
Applicant desires passport sent to following address:
Katerina Filipek
5241 W. Quincy St.
Chicago, Illinois