◆ SpookStack

[i o ae ‘OREIGN COUNTRIES VISITED OR RESIDED — ° : _ SITY AHD COURTRY . jp | OATE LEFT U.S. | DATE RETURNED v.s. PURPOSE 4 Hiagara » Ontario, Canada July 196 July 196 Sightseeing ~ 1 Day ‘ : . : (Vacation) Toronto; Cntario, Canada ‘| July 1917 July 197 Sightseeing - 1 Week 4 . (Vacation) ; Winipeg, Manitoba, Canada, .. | duly 198 July 198 Sightseeing - 1 Week | re ” ; (Vacation) - i ’ ‘ as “* — I qt. RELATIVES - : 4 LIST PARENTS, SPOUSE, FORMER SPOUSE(S), (including maiden name) CHILDREN, BROTHERS, AND SISTERS (16 years and older) List § | _ EVEN THOUGH DECEASED. d ~ : . AOORESS PLACE & DATE |, PRESENT ; : RELATION . . ~ NAME. (Enter “deceased” If no longor tiving) |* OF BIRTH CITIZENSHIP fi } Mother Leonore M. C. Livezly Deceased 26 June 1872 U.S.A. | 4 (Cleveland) Newark, N. J. i ' Father Deceased, Archer F. Livezly 13 Feb 1873 U.S.A. 3 Newport, N.| J. a : i Fb. LIST OTHER LIVING RELATIVES ANO RELATIVES OF SPOUSE AND FORMER SPOUSE(S) KNOWN TO BE RESIOING OUTSIOE THE WU. gs. Pe errant Sn ene ans g 19. EMPLOYMENT (Show every employment you have had in last 15 years or from 18th birthday which evee is shorter and account for all periods of unemployment) . | ADDRESS : re ee ff s