Required by the regulations of the Secretary of Commerce and Labor of the United States, under Act of Congress approved March 3, 1903, to be delivered to the U.S. Immigration Officer, by the Commanding Officer of any vessel having such passengers on board upon arrival at a port in the United States.
S.S. "Willehad" sailing from Kristiansan, S, 2nd. july, 1904 Arriving at Port of New York July 15, 1904
| No. on List | 3 | 4 | 5 | 6 | 7 |
| Name in Full | Oline Ber?ine Forslin | Emanual Forslin | Joahnnes Forslin | Ellen Katherine Forslin | Olga Gustava Forslin |
| Age | 42 | 12 | 10 | 8 | 3 |
| Sex | w | m | m | w | w |
| Married or Single | m | s | s | s | s |
| Calling or Occupation | wife | boy | boy | girl | girl |
| Able to Read | yes | yes | yes | yes | no |
| Able to Write | yes | yes | yes | yes | no |
| Nationality (Country of which citizen or subject) | Norwegian | Norwegian | Norwegian | Norwegian | Norwegian |
| Race or People | Scandinavian | Scandinavian | Scandinavian | Scandinavian | Scandinavian |
| Last Residence (Last permanent residence, Country and City or Town) | Arendal | Arendal | Arendal | Arendal | Arendal |
| Final Destination (State, City, or Town) | Chicago | Chicago | Chicago | Chicago | Chicago |
| Whether having a ticket to such final destination | Yes | Yes | Yes | Yes | Yes |
| By whom was passage paid? | husb | father | father | father | father |
| Whether in possession of $50, and if less, how much? | $18.00 | ||||
| Whether ever before in the United States; and if so, when, and where? | no | ||||
|
Whether going to join a relative or friend; and if so,
what relative or friend, and his name and complete address |
husband: Gustave Inglebear? Forslein 647 Haddece? Ave Chicago | ||||
|
Ever in prison or almshouse, or institution of care and
treatment of the insane, or supported by charity? If so, which? |
no | ||||
| Whether a Polygamist? | no | ||||
| Whether an Anarchist? | no | ||||
|
Whether coming by reason of any offer, solicitation?, or promise,
or agreement, express or implied, to labor in the United States |
no | ||||
| Condition of Heath, Mental and Physical | good | ||||
| Deformed or crippled. Nature, length of time, and cause | no | ||||
Source: Year: 1904; Arrival: New York, New York, USA; Microfilm Serial: T715, 1897-1957; Line: 7; Page Number: 134
Source: Ancestry.com. New York Passenger Lists, 1820-1957