Partial Transcript

1921
           S.S. CANADA
         PASSENGER’S DECLARATION
1 NAME MILDRED HART
2 Age 24 Female Single Occupation Teacher
Intended Occupation Home
3 Birthplace Ashton-in Makerfield Race or People English
4 Citizenship British
5 Religion Church of England
6 Object in coming to Canada Marriage
7 Ever lived in Canada No
9 Money in possession belonging to immigrant $50
10 Able to read? Yes Can you write? Yes
11 What language? English
12 By whom was passage paid? Self
13 Intend to remain permanently in Canada Yes
15 Destined to friend Mr. R. Woods
321 Hibernia Road, Point St Charles, Montreal
17 Nearest relative in country from which passenger came
                              Relationship Father
                              Name Mr. B. Hart
                              Address in Full 3 Mellingford Cottage, Bolton Rd., Ashton-in-Makerfield
18 If ever in insane asylum state where … No
19 Ever had tuberculosis or epilepsy? No
20 Physical defective No
Signature of passenger Mildred Hart Date 6th Jany/21