UNITED STATES OF AMERICA Department of Commerce and Labor Bureau of Immigration and Naturalization Division of Naturalization DECLARATION OF INTENTION (Invalid for all purposes seven years after the date hereof) State of Oregon County of Lane In the Circuit Court of Lane County, Oregon I. Wali Fred Dad, aged 24 years, occupation, Restaurant Keeper, do declare on oath that my personal description is: Color White, complexion, dark, height 5 feet 8 inches, weight 140 pounds, color of hair, black, color of eyes, brown other distinctive marks none; I was born in Hong Kong, China on the 14th day of Feb. anno Domini, 1882; I now reside at 89 West Eighth Street in Eugene, Oregon. I emigrated to the United States of America from Hong Kong China on the vessel Do not know, large steam one, my last foreign residence was Hong Kong, China. It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign prince, potentate, state, or sovereignty, and particularly to Alphonso XIII King of Spain, of which I am now a subject; I arrived at the port of San Francisco, in the State/Territory/District of California on or about the day of January, anno Domini, 1904; I am not an anarchist; I am not a polygamist nor a believer in the practice of polygamy; and it is my intention in good faith to become a citizen of the United States of America and to permanently reside therein; SO HELP ME GOD. Wali Fired Dad (original signature of declarant)