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{
    "localId": "159596813",
    "label": "File numbers 4874 - 5509, 1926-1930",
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    "contentType": "document",
    "title": "File numbers 4874 - 5509, 1926-1930",
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        "Naturalization Records of Non-Federal Courts in Connecticut",
        "Applications for Declaration of Intention"
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{
    "seq": 102,
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    "ocrText": "4925\nForm 2213\nRATURALIZATION SERVIOE\nFACTS FOR DECLARATION OF INTENTION\nREQEIVED\nCleric of Court:\nPlace\nof ell copies of d claration immediately under\nnumber 25653 in upper left-band\ncorner\nOOT 29 1926\nyour declaration namber,\nU. S. DEPARTMENT OF LABOR\nDirsetor of Naturaliz- NATURALIZATION\nSERVICE\nOFFICE OF EXAMINER\nBoston, Mses,\nNEW HAVEN, CONN.\nDEPARTMENT OF LABOR\nNOTE.-A copy of this form will be furnished by the clerk of the court, the Chief Naturalization Examiner, or the\npublic=school teacher to each applicant for a declaration of intention, so that he can at his leisure fill in the answers to\nthe questions. After being filled out the applicant should take the form to the offico of the clerk of court to be used\nby him in properly filling out the doclaration. Care should be used to state as near as can be remembered the day,\nmonth, and year of arrival, as woll as the name of the vessol on which the alien emigrated to this country.\nTO THE APPLICANT.-Th fee of one dollar required by law for the declaration, must be paid to the clerk of the\ncourt beforo he commences to fill out the declaration of intention. No feo is chargeable for this blank, and none\nshould be paid for assistance in filling it out, as the Naturalization Examiner or the public-school teacher will help you\nfree of charge.\nGottliel Erich Niedmann\n24\nMyname is\nAge:\nyears.\n(Alien should state here his true, original, and correct name in full.)\n(Give age at last birthday.)\nAlso known as\n(If alien has used any other name in this country, that name should be shown on line immediately above.)\nOccupation:\nEngineer\nColor.: white\nHeight:\nfive\nfeet 104/2-even\nComplexion: fair light\ninches. Weight: 155\npounds.\nColor of hair: blow fant light Color of eyes: blue\nOther visible distinctive marks:\navertyianna (If no visible distinctive marks, so state.)\nnone\nWhere born: Micholage (City town.) micheling Gechaslooaria (Country.) (Europe)\nor\nDate of birth:\nApril\n7th\n.\n1902\n,\n(Month.)\n(Day.)\n(Year.)\nPresent residence:\n60. allen Str.\ngroton\nConn. u.s.a.\n,\n,\n(Number and street.)\n(City or town.)\n(State, Territory, or District.)\nEmigrated from:\n(Place on or come\nGermany where alien got ship train to (Hamburg) to the United States.) Germany (Country.)\nName of vessel:\nalbert Ballin\n(If the alien arnived otherwise than by vessal, thecharacter of convey) once or name of transportationicompany should be given.)\nLast place of foreign residence:\nsald (City town.) Ezechoslovation (Country.)\nor\n*I am not married; the name of my swife (hrusband) is\n(she)\n; the ) was\n*born at\n; and now resides at\nThe German Empire\nRuich\nI am now a subject of and intend to renounce allegiance to\nof\nMy\n:\nRepublic Germany\nNO,\n(Write name and title of sovereign and country af which now a subject; or if citizen of a Republic, write namo of Republic only\nI\narrived at the port of New York City\nN.Y.\nwrong to\n,\n(City or town.\n(State or Territory.)\non OT about\nSeptember\n6th\n9\n7\n1926\n(Month.)\n(Day.)\n(Year.)\n* NOTE TO CLERK OF COURT.-The two lines indicated by the contain information which is provided for by blanks on the latest\ndeclaration of intention form; until such time as you may be supplied with forms containing these blank spaces the information called\nfor herein should be inserted immediately ABOVE the twelfth line, which begins \" It is my bona fide intention,' etc., as requested\nin\ncircular letter of January 5, 1916.\nGOVERNMENT PRINTING OFFICE\n14-8\nO/A ISSUED\nNOV 30 1996"
}