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34364
NATURALIZATION SERVICE
Form 2213
RECEIVED
FACTS FOR DECLARATION OF INTENTION
JUN 16 7027
5471
U.S. DEPARTMENT OF LABOR
GF EXAMINER
NATURALIZATION SERVICE
NUW CONN.
yo LABOR
NOTE.-A copy of this form will be furnished by the clork of the court, the Chief Naturalization Examiner, or the
public-school teacher to each applicant for a declaration of intention, so that ho can at his leisure fill in the answers to
the questions. After being filled out the applicant should tako the form to the office of the clerk of court to be used
by him in properly filling out the declaration. Caro should be used to state as near as can be remembered
the
day,
month, and year of arrival, as well as the name of the vessel on whien the alien emigrated to this country.
TO THE APPLICANT.-The fee of one dollar required by law for the declaration, must be paid to the clerk of the
court before he commences to fill out the declaration of intention. No feo is chargeable for this blank, and none
should be paid for assistance in filling it out, as the Naturatization Examiner or the public-school teacher will help you
free of charge.
My name is
sima (Alien should state Sylegingier here his true, original, and correct
Age:
42
years.
name in full.)
(Give age at last birthday.)
Also known as S. ophie Shlesinger
(Ifalien has used any other name in iscountry, that name should be shown on line immediately above.)
Occupation: housewife
Color:
White
Complexion: fair
Height:
5
slight feet
# 4/4 inches. Weight: 165 pounds.
Color of hair: gray
-
Color of eyes:
brown
Other visible distinctive marks:
none
(Ifno visible distinctive marks, so state.)
Where born: Backi, Gradno ,
Paland
(City or town.)
(Country.)
Date of birth:
December
third
1885
,
,
(Day.)
(Year.)
Present residence: (Month.) (Number and street.) , (City or town.) , (State, Coun.
Broadway
Jolchester
Territory, or District.)
Emigrated from: (Place Biala, where alien got on ship or Bodf train toscome to
Poland
NATURA
the United States.)
(Country.)
Name
otherwise than by vessel, the character of conveyance or name of transportation company should be given.)
Last placg UN foreign residence:
Biala Padl
Paland
(City or town.)
(Country.)
*I am
application
17 the name of my thiskands is Solomon Ahlesinger; the shet was
AL OF Grodno
; and now resides at Calchester Coun
N.
I am now a OF intend to renounce allegiance to The Republic
of (Write Paland.
name and title of sovereign and country of which now a subject; or if citizen of a Republic, write name of Republiconly.)
Elizabeth on or about (Month.)
Ifarrived at the port of new (City or town.)
York
frew (State/or York. Territory.)
fourth
1923
,
,
(Day.)
(Year.)
* Nort TO CLERK OF COURT.-The two lines indicated by the * contain information which is provided for by blanks on the latest
declaration of intention form; until such time as you may be supplied with forms containing these blank spaces the information called
for-berein should be inserted immediately ABOVE the twelfth line, which begins It is my bona fide intention,' etc., as requested in
circular letter of January 5, 1916.
(18-6-7404
14-8
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"ocrText": "34364\nNATURALIZATION SERVICE\nForm 2213\nRECEIVED\nFACTS FOR DECLARATION OF INTENTION\nJUN 16 7027\n5471\nU.S. DEPARTMENT OF LABOR\nGF EXAMINER\nNATURALIZATION SERVICE\nNUW CONN.\nyo LABOR\nNOTE.-A copy of this form will be furnished by the clork of the court, the Chief Naturalization Examiner, or the\npublic-school teacher to each applicant for a declaration of intention, so that ho can at his leisure fill in the answers to\nthe questions. After being filled out the applicant should tako the form to the office of the clerk of court to be used\nby him in properly filling out the declaration. Caro should be used to state as near as can be remembered\nthe\nday,\nmonth, and year of arrival, as well as the name of the vessel on whien the alien emigrated to this country.\nTO THE APPLICANT.-The fee of one dollar required by law for the declaration, must be paid to the clerk of the\ncourt before 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 Naturatization Examiner or the public-school teacher will help you\nfree of charge.\nMy name is\nsima (Alien should state Sylegingier here his true, original, and correct\nAge:\n42\nyears.\nname in full.)\n(Give age at last birthday.)\nAlso known as S. ophie Shlesinger\n(Ifalien has used any other name in iscountry, that name should be shown on line immediately above.)\nOccupation: housewife\nColor:\nWhite\nComplexion: fair\nHeight:\n5\nslight feet\n# 4/4 inches. Weight: 165 pounds.\nColor of hair: gray\n-\nColor of eyes:\nbrown\nOther visible distinctive marks:\nnone\n(Ifno visible distinctive marks, so state.)\nWhere born: Backi, Gradno ,\nPaland\n(City or town.)\n(Country.)\nDate of birth:\nDecember\nthird\n1885\n,\n,\n(Day.)\n(Year.)\nPresent residence: (Month.) (Number and street.) , (City or town.) , (State, Coun.\nBroadway\nJolchester\nTerritory, or District.)\nEmigrated from: (Place Biala, where alien got on ship or Bodf train toscome to\nPoland\nNATURA\nthe United States.)\n(Country.)\nName\notherwise than by vessel, the character of conveyance or name of transportation company should be given.)\nLast placg UN foreign residence:\nBiala Padl\nPaland\n(City or town.)\n(Country.)\n*I am\napplication\n17 the name of my thiskands is Solomon Ahlesinger; the shet was\nAL OF Grodno\n; and now resides at Calchester Coun\nN.\nI am now a OF intend to renounce allegiance to The Republic\nof (Write Paland.\nname and title of sovereign and country of which now a subject; or if citizen of a Republic, write name of Republiconly.)\nElizabeth on or about (Month.)\nIfarrived at the port of new (City or town.)\nYork\nfrew (State/or York. Territory.)\nfourth\n1923\n,\n,\n(Day.)\n(Year.)\n* Nort 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-berein should be inserted immediately ABOVE the twelfth line, which begins It is my bona fide intention,' etc., as requested in\ncircular letter of January 5, 1916.\n(18-6-7404\n14-8"
}