Application to emigrate to Guyana

* Information to be supplied by persons desirous of immigration into Guyana.

1. Full name (block capitals, surnames first)
   Willis, Mary
2. Address
   1435 Alvarado Terrace, L.A. Calif.
3.  Nationality
   USA
4. Date of birth
   December 21, 1940
5. Place of birth
   Rayville, Louisiana
6. Profession, trade or occupation
   L.V.N. Practical nurse
7. Married or single
   Single
8. Wife’s (husband’s) name and nationality
   None
9. Names and dates of birth of dependent children
   None
10. Schools and other educational institutions attended and periods of absence
    Richwood high, nursing school
11. Academic, professional, technical, and other qualifications
    Works on automobiles, study mathematics
12. Assets (including cash)
    Yes
13. State whether you are prepared to work and live in the interior of Guyana
    Yes