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File numbers 4874 - 5509, 1926-1930

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Form 2213 PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN 5394 U. S. DEPARTMENT OF LABOR NOT TO BE FILLED IN BY ALIEN FOR USE OF OFFICIALS SEARCHING IMMI- NATURALIZATION SERVICE GRATION RECORDS CLERK OF COURT: RECORDS EXAMINED Place number in CARD INDEX upper left-hand corner of all copies of declaration, immediately under your INDEX BOOKS declaration number. DISTRICT DIRECTOR OF NATURALIZATION MANIFESTS I desire to file my Declaration of Intention (first paper) to become a citizen. Mr. My name is Mrs. Justina (Alien should print typeyrite SiENkows here true, original, and correct name) K ; age, 42 years. or (Give age last birthday) My present occupation is merchant My personal description is: Color, white ; complexion, fair ; height, 5 feet 3 inches; weight, 176 pounds; color of hair, brown ; color of eyes, blue ; other visible distinctive marks: none I was born in Piaseigno, (City or town) Russia, now Poland (Country) on the 15 day of , 1886 My present residence is 88 St. rew London Winstrop June Conn. (Number and street) (City or town) (County) (State) The place where I took the ship or train which landed me in the United States was antwerp, Belgium , on June 12 1911 The name of the ship of railroad on which I came was 7arlerdamo (Month) Vaterland (Day) (Year) My last place of foreign residence was/ said (City or town) I am not married. The name of my Ciasegno Roland (Country) wife She is was born at husband He , and now resides at , I am now a subject of and intend to renounce allegiance to Poland (Write name and title of sovereign and country of which now a subject; or, if citizen of a republic, write name of republic only) I arrived at the United States immigration port of newlfash new york (City tity town) or (State or territory) , on June 14-8 (Give 23 exact month, day, 1911 and year) (OVER)

Page data

Page
1039
Source index
0
Type
photo
Media ID
697bd8d184063a0d
Size
unknown

Document data

ID
159596813
Core
doc
Type
document
DTO data 
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Context sent to Scholar

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    "ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5394\nU. S. DEPARTMENT OF LABOR\nNOT TO BE FILLED IN BY ALIEN\nFOR USE OF OFFICIALS SEARCHING IMMI-\nNATURALIZATION SERVICE\nGRATION RECORDS\nCLERK OF COURT:\nRECORDS EXAMINED\nPlace number\nin\nCARD INDEX\nupper left-hand corner of all copies of\ndeclaration, immediately under your\nINDEX BOOKS\ndeclaration number.\nDISTRICT DIRECTOR OF NATURALIZATION\nMANIFESTS\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nJustina (Alien should print typeyrite SiENkows here true, original, and correct name) K ; age,\n42 years.\nor\n(Give age last birthday)\nMy\npresent occupation is merchant\nMy personal description is: Color, white ; complexion, fair\n; height, 5 feet 3 inches;\nweight, 176 pounds; color of hair, brown ; color of eyes, blue\n;\nother visible distinctive marks:\nnone\nI was born in\nPiaseigno,\n(City or town)\nRussia, now Poland (Country)\non the\n15 day of\n, 1886\nMy present residence is 88 St. rew London\nWinstrop\nJune\nConn.\n(Number and street)\n(City or town)\n(County)\n(State)\nThe place where I took the ship or train which landed me in the United States was\nantwerp, Belgium\n, on\nJune\n12 1911\nThe name of the ship of railroad on which I came was\n7arlerdamo (Month) Vaterland (Day) (Year)\nMy last place of foreign residence was/ said (City or town)\nI am not married. The name of my\nCiasegno\nRoland\n(Country)\nwife\nShe\nis\nwas born at\nhusband\nHe\n, and now resides at\n,\nI am now a subject of and intend to renounce allegiance to\nPoland\n(Write name and title of sovereign and country of which now a subject;\nor, if citizen of a republic, write name of republic only)\nI arrived at the United States immigration port of\nnewlfash\nnew york (City tity town)\nor\n(State or territory)\n, on June 14-8 (Give 23 exact month, day, 1911 and year)\n(OVER)"
}