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Form 2218
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
#942
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
(NOTE TO CLERK OF COURT.-To guide you in preparing the Declaration: The black face lines on this form contain
statements
in the regular order as they are to appear on the Declaration of Intention.)
I desire to file Declaration of Intention to become citizen.
Mr.
My name is
Mrs.
Shawneld my Suppezentia (first paper) name) a
; age, 4546
years.
Miss
Stanley (Alien should print Lukhcyz here true, original, and correct
or
(Give age last birthday)
Also known as
If alien has used any other name in this country, that name should be shown here)
I used that name because easy to proviuence
The full name of the person shown on my steamship ticket was Stanidan Rubsrenter
My mother's maiden name was locktoya Biegouis
My name was (if woman) laborr
maiden
My My present personal occcupation description is is: Color, White ; complexion, leght fair ; height, 5 feet 3, 4 inches;
weight, 162 pounds; color of hair, left ; color of eyes,
I was other born visible in giralka distinctive marks: (City scar or toyn) on More Pulaned (Country) Lithuamia
on the
28
day of
October
1880
My present residence is 12 White Stay Norrich, (Comnty) bacen
(Number and street)
(City or town)
(State)
My post office address is
same
The
place where I took the ship or train which landed me in the United States was
Germany
on heave (Month) 29, Ray) 1909. (Year)
Housturg
,
The ticket which I this country bought Patricia Banting (Gity) Geruany (Country)
on came to was at
The name of the ship or railroad on which I came was
(OVER)
014-8
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Document data
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"ocrText": "Form 2218\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n#942\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\n(NOTE TO CLERK OF COURT.-To guide you in preparing the Declaration: The black face lines on this form contain\nstatements\nin the regular order as they are to appear on the Declaration of Intention.)\nI desire to file Declaration of Intention to become citizen.\nMr.\nMy name is\nMrs.\nShawneld my Suppezentia (first paper) name) a\n; age, 4546\nyears.\nMiss\nStanley (Alien should print Lukhcyz here true, original, and correct\nor\n(Give age last birthday)\nAlso known as\nIf alien has used any other name in this country, that name should be shown here)\nI used that name because easy to proviuence\nThe full name of the person shown on my steamship ticket was Stanidan Rubsrenter\nMy mother's maiden name was locktoya Biegouis\nMy name was (if woman) laborr\nmaiden\nMy My present personal occcupation description is is: Color, White ; complexion, leght fair ; height, 5 feet 3, 4 inches;\nweight, 162 pounds; color of hair, left ; color of eyes,\nI was other born visible in giralka distinctive marks: (City scar or toyn) on More Pulaned (Country) Lithuamia\non the\n28\nday of\nOctober\n1880\nMy present residence is 12 White Stay Norrich, (Comnty) bacen\n(Number and street)\n(City or town)\n(State)\nMy post office address is\nsame\nThe\nplace where I took the ship or train which landed me in the United States was\nGermany\non heave (Month) 29, Ray) 1909. (Year)\nHousturg\n,\nThe ticket which I this country bought Patricia Banting (Gity) Geruany (Country)\non came to was at\nThe name of the ship or railroad on which I came was\n(OVER)\n014-8"
}