Formulaire pour les arrivées par la frontière utilisé entre 1925 et 1930
(Disponible en anglais seulement)
1. Line
2. Day of month
3. Family name, given name
4. Relationship
Age
5. M.
6. F.
7. Single, married, widowed or divorced
8. County, state and place of birth
9. Nationality (country of which a citizen or subject)
10. Race or people
If in Canada Before
11. Between what periods
12. At what address
13. What language? (If unable to read insert "nil")
14. Religion. State Denomination
Occupation
15. What trade or occupation did you follow in your own country?
16. What trade or occupation do you intend to follow in Canada?
Destination
17. If destined to relative, friend or employer state which and give name
and full address. If not joining any person in Canada, give the address in
Canada to which you are going
18. Give name, relationship and address of your nearest relative in the
country from which you came
Have you or any of your family ever been
19. Mentally defective
20. Physically defective
21. Tubercular
22. Money in possession belonging to passenger
23. Value of effects
24. Travelling inland on state railway or highway
25. Action taken. State whether admitted as immigrant or non-immigrant
or rejected. If rejected, give cause and state if appeal entered