Form Templates Introduction

List ____________ List ____________

Form 500 B
U.S. DEPARTMENT OF LABOR The entries on this sheet must
IMMIGRATION SERVICE be typewritten or printed.

LIST OR MANIFEST OF ALIEN PASSENGERS FOR THE UNITED STATES IMMIGRATION OFFICER AT PORT OF ARRIVAL

ALL ALIENS arriving at a port of continental United States from a foreign port or a port of the insular possessions of the United States, and all aliens arriving at a port of said insular possessions from a foreign port, a port of continental United States, or a port of another insular possession in whatsoever class they travel, MUST be fully listed and the master or commanding officer of each vessel carrying such passengers must upon arrival deliver lists thereof to the immigration officer.
This (white) sheet is for the listing of STEERAGE PASSENGERS ONLY

S.S. ___________________________ Passengers sailing from _________________________, _______________, 191__

Arriving at Port of ___________________ , ___________ 191__

1 No. on List. ____
2 HEAD-TAX STATUS. (This column for use of Government officials only.)
3 NAME IN FULL. Family Name. Given Name.
___________________________________________
4 Age. Yrs. Mos.____ ____
5 Sex. ________
6 Married or single. ______
7 Calling or occupation. ___________
8 Able to -- Read Read what language (or, if exemption claimed, on what ground) Write
____ _____________ _____
9 Nationality. (Country of which citizen or subject.)
__________________
10 ‡ Race or People. _____________
11 * Last Permanent Residence. Country. City or town.
____________________ __________________
12 The name and complete address of nearest relative or friend in country whence alien came.
_________________________________________________________
13 Final Destination. *(Intended future permanent residence.) State. City or town.
___________________ _________________

* Permanent residence within the meaning of this manifest shall be actual or intended residence of one year or more.
‡ List of races will be found on back of this sheet.

[2ND PAGE]

14 No. on List. ____
15 Whether having a ticket to such final destination. _____
16 By whom was passage Paid? (Whether alien paid his own passage, whether paid by relative, whether paid by any other person, or by any corporation, society, municipality, or government.) ___________________
17 Whether in possession of $50, and if less, how much? ____________
18 Whether ever before in the United States; and if so, when and where? Yes or No. If Yes -- Year or period of years. Where?
_______________ _______________ _____________
19 Whether going to join a relative or friend; and if so, what relative or friend, and his name and complete address.
_________________________________________________________________
20 Purpose of coming to United States. Whether alien intends to return to country whence he came after engaging temporarily in laboring pursuits in the United States. Length of time alien intends to remain in the United States. Whether alien intends to become a citizen of the United States.
__________________ ________________ _______________
21 Ever in prison or almshouse, or institution for care and treatment of the insane, or supported by charity? If so, which?
_______________________________
22 Whether a Polygamist. _____
23 Whether an Anarchist. _____
24 Whether a person who believes in or advocates the overthrow by force or violence of the Government of the United States or all forms of law, etc. (See footnote for full text of this question.) ______
25 Whether coming by reason of any offer, solicitation, promise, or agreement, expressed or implied, to labor in the United States.
______
26 Whether alien has been previously deported within one year.
______
27 Condition of health, mental and physical.
______
28 Deformed or Crippled. Nature, length of time, and cause.
______
29 Height. Feet. Inches.
____________
30 Complexion. __________
31 Color of -- Hair. Eyes. _______________ ____________
32 Marks of Identification. _________________________
33 Place of Birth. Country. City or Town.
_______________ ______________

NOTE. -- Full text of question 24 is as follows: Whether a person who believes in or advocates the overthrow by force or violence of the Government of the United States or all forms of law, or who disbelieves in or is opposed to organized government, or who advocates the assassination of public officials, or who advocates or teaches the unlawful destruction of property, or is a member of or affiliated with any organization entertaining and teaching disbelief in or opposition to organized government or which teaches the unlawful destruction of property, or who advocates or teaches the duty, necessity, or propriety of the unlawful assaulting or killing or any officer or officers, either of specific individuals or of officers generally, of the Government of the United States or of any other organized government because of his or their official character.

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