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I, Chas. Boettger, Captain of the S.S. Gdansk, from Danzig, do solemnly, sincerely and truly state that I have caused the surgeon of said vessel sailing therewith, or the surgeon employed by the owners thereof, to make a physical and mental examination of each and all the aliens named in the foregoing Lists or Manifest Sheets, 13 in number, and that from the report of said surgeon and from my own investigation, I believe that no one of said aliens is of any of the classes excluded from admission into the United States by section three of the Immigration Act, and that also, according to the best of my knowledge and belief, the information in said Lists or Manifests concerning each of said aliens named therein is correct and true in every respect.

Sworn to me this 17 day of March, 1921
at Boston, Mass.

I, Ernest Hirrschoff, Surgeon of the S.S. Gdansk, sailing therewith, do solemnly and truly declare that I have had two years experience as a Physician and Surgeon, and that I am entitled to practice as such by and under the authority of the State of Delaware, and that I have made a personal examination of each of the aliens named herein, and that the foregoing Lists or Manifest Sheets, 13 in number, according to the best of my knowledge and belief, are full and correct, and true in all particulars, relative to the mental and physical condition of such aliens.

Sworn to me this 17 day of March, 1921
at Boston, Mass.

US Citizens sailing from Danzig  March 1, 1921 arriving Boston, March 17, 1921

Columns represent:
 1)  No. on list
 2)  Name in Full: Family Name, Given Name
 3)  Age Yrs, Mos.
 4)  Sex
 5)  Married or Single
 6)  If Native of United States insular possession or if native of United States , give date 
     and place of birth (city or town and state)
 7)  If naturalized, give name and location of court which issued naturalization papers and 
     date of papers.
 8)  Address in United States

38  Koczwanski, Mieczyslaw
39  Koczwanski, Stefanja
40  Dlugokencki, Zygmunt

38  Koczwanski, Mieczyslaw;     Age: 34 Yrs, 5 Mos.;  Sex: M;   Married/Single: M       
        If Native: Naturalized
        If Naturalized: U.S.A. Circuit Court, Providence, RI, 19 Sept. 1911
      Address in U.S.:  161-15th Street, Brooklyn, N.Y.

39  Koczwanski, Stefanja;       Age: 27 Yrs, 1 Mos.;  Sex: F;   Married/Single: M       
      If Native: USC
        If Naturalized: By marriage to the above named.
      Address in U.S.:  161-15th Street, Brooklyn, N.Y.

40  Dlugokencki, Zygmunt;       Age: ?3 Yrs, 10 Mos.;  Sex: M;   Married/Single: M      
      If Native: Naturalized
        If Naturalized: U.S.A. 1912, Bridgeport Conn.
      Address in U.S.:  Stratford Ave. St. 60


Transcriber's Notes:

* An asterisk indicates an error on the part of the original recorder, not the transcriber,
   or calls attention to additional information in the transcriber notes.
? Question marks within the text indicate illegible handwriting or entries obscured by
   other markings.

National Archives and Records Administration, Film T843, Reel 262, Vol. 426-427.

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