https://scholarlycommons.pacific.edu/cook-nisei/1132/thumbnail.jp

Selective Service System

Scholarly Commons

University of the Pacific Scholarly Commons Guy and Marguerite Cook Nisei Collection Japanese-American Internment Collections 7-31-1943 WRA Form: Statement of US Citizen of Japanese Ancestry, [July 1943] Selective Service System Follow this and additional works at: https://scholarlycommons.pacific.edu/cook-nisei Recommended Citation Selective Service System, "WRA Form: Statement of US Citizen of Japanese Ancestry, [July 1943]" (1943). Guy and Marguerite Cook Nisei Collection. 133. https://scholarlycommons.pacific.edu/cook-nisei/133 This Ephemera is brought to you for free and open access by the Japanese-American Internment Collections at Scholarly Commons. It has been accepted for inclusion in Guy and Marguerite Cook Nisei Collection by an authorized administrator of Scholarly Commons. For more information, please contact mgibney@pacific.edu. FORM APPROVED BUDGET BUREAU NO. 33-R045-43 GUY W. COOK NISEI COLLECTION University of The Pacific (LOCAL BOARD DATE STAMP WITH CODE) STATEMENT OF UNITED STATES CITIZEN OF JAPANESE ANCESTRY 1. (Surname) (English given name) (Japanese given name) ( a )  Alias 2. Local selective service board (Number) (City) (County) 3. Date of birth Place of birth . (State) 4. Present address "(Street) (City) (State) 5. Last two addresses at which you lived 3 months or more (exclude residence at relocation center and at assembly center): . From . From To . . T o .  6. Sex Height Weight 7. Are you a registered voter? Year first registered Where? Party — 8. Marital status Citizenship of wife Race of wife 9. 10. (Father's Name) (Mother's Name) (Town or Ken) (State or Country) (Occupation) (Birthplace) (Town or Ken) (State or Country) (Occupation) (Birthplace) In items 11 and 12, you need not list relatives other than your parents, your children, your brothers and sisters. For each person give name; relationship to you (such as father); citizenship; complete address; occupation. 11. Relatives in the United States (if in military service, indicate whether a selectee or volunteer); (a) (&) to -(Name) (Relationship to you) (Citizenship) (Complete address) (Occupation) (Volunteer or selectee) (Name) (Relationship to you) (Citizenship) (Complete address) (Occupation) (Volunteer or selectee) (Name) (Relationship to you) (Citizenship) DSS Form 304A (1-23-43) (Complete address) (Occupation) ( I f  a d d i t i o n a l  s p a c e  i s  n e c e s s a r y ,  a t t a c h  s h e e t s )  (Volunteer or selectee) 16-32565-1 12. Relatives in Japan (see instruction above item 11): (Name) (Relationship to you) (Citizenship) (Complete address) (Occupation) (Name) (Relationship to you) (Complete address) 13. Education: Name Place (Kindergarten) (Grade school) (Japanese language school) (High school) (Junior college, college, or university) (Citizenship) (Occupation) Years of attendance From to From to . From to . From to . From to . (Type of military training, such as R. O.T. C. or Gunji Kyoren) (Where and when) (Other schooling) (Years of attendance) 14. Foreign travel (give dates, where, how, for whom, with whom, and reasons therefor): 15. Employment (give employers' names and kind of business, addresses, and dates from 1935 to date): 16. Religion Membership in religious groups 17. Membership in organizations (clubs, societies, associations, etc.). Give name, kind of organization, and dates of membership. 1&—32565-1 18. Knowledge of foreign languages (put check mark (V) in proper squares): (a) Japanese > Reading Writing Speaking 19. Sports and hobbies Good Fair Poor (6) Other Good (Specify) n n n n • n • n Reading EZ3 Writing • Speaking • Fair • • • Poor • • • 20. List five references, other than relatives or former employers, giving address, occupation, and number of years known: ("Name) (Complete address) (Occupation) (Years known) 21. Have you ever been convicted by a court of a criminal offense (other than a minor traffic violation)? Offense When What court Sentence 22. Give details on any foreign investments. (а) Accounts in foreign banks. Amount, $ Bank Date account opened (б) Investments in foreign companies. Amount, $ Company Date acquired (c) Do you have a safe-deposit box in a foreign country? ^ What country? Date acquired Contents """ 19—32685-1 23. List contributions you have made to any society, organization, or club: Organization Place Amount Date 24. List magazines and newspapers to which you have subscribed or have customarily read: 25. To the best of your knowledge, was your birth ever registered with any Japanese governmental agency for the purpose of establishing a claim to Japanese citizenship? ( a )  If so registered, have you applied for cancelation of such registration? _ (Yes or no) When? Where? 26. Have you ever applied for repatriation to Japan? • 27. Are you willing to serve in the armed forces of the United States on combat duty, wherever ordered? — 28.. Will you swear unqualified allegiance to the United States of America and faithfully defend the United States from any or / all attack by foreign or domestic forces, and forswear any form of allegiance or obedience to the Japanese emperor, or any other foreign government, power, or organization? (Date) (Signature) NOTE.—Any person who knowingly and wilfully falsifies or conceals a material fact or makes a false or fraudulent statement or representation in any matter within the jurisdiction of any department or agency of the United States is liable to a fine of not more than $10,000 or 10 years' imprisonment, or both. U. S. GOVERNMENT PRINTING OFFICE 16 32565-1 

English

WRA Form: Statement of US Citizen of Japanese Ancestry, [July 1943]

Pacific McGeorge School of Law

https://scholarlycommons.pacific.edu/cgi/viewcontent.cgi?article=1132&context=cook-nisei

WRA Form: Statement of US Citizen of Japanese Ancestry, [July 1943]

Abstract

Similar works

Full text

Available Versions

Scholarly Commons

Pacific McGeorge School of Law