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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4943
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 my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrsr
Apolinary Alien should print or typeprite here Homorowski true, original, and correct name) ;
age,
3230 years.
Miss
(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
The full
name of the person shown on my steamship ticket was Apolicary hourrointi
My name
mother's maiden was Frances Prickop
My maiden name was (if woman)
blacksmith
My My personal present occcupation description is is: Color, while ; complexion, family ; height, 5 feet 61/2 inches;
weight, 145 pounds; color of hair, brown
;
color of eyes, blue
;
other visible distinctive marks: an
middle was born in Suwacks furger life . Russin had Palaned now Poland
small thursday searson
I
(City) or town)
(Country)
on
the of
My present residence is 380 nothanis, Nornich , feru
luly
1896
(Number and street)
(City or town)
(County)
(State)
My
post office address is same as above
The
place where I took the ship or train which landed me in the United States was Hamburg
The ticket on which I came to this country was bought at Grosthi (Month) (City) Germany (Day) (Country) (Year)
Germany on "
The name of or on came was
the ship railroad which I (OVER) SS. President grant 014-8
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4943\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 statements\nin the regular order as they are to appear on the Declaration of Intention.)\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrsr\nApolinary Alien should print or typeprite here Homorowski true, original, and correct name) ;\nage,\n3230 years.\nMiss\n(Give age last birthday)\nAlso known as\n(If alien has used any other name in this country, that name should be shown here)\nI used that name because\nThe full\nname of the person shown on my steamship ticket was Apolicary hourrointi\nMy name\nmother's maiden was Frances Prickop\nMy maiden name was (if woman)\nblacksmith\nMy My personal present occcupation description is is: Color, while ; complexion, family ; height, 5 feet 61/2 inches;\nweight, 145 pounds; color of hair, brown\n;\ncolor of eyes, blue\n;\nother visible distinctive marks: an\nmiddle was born in Suwacks furger life . Russin had Palaned now Poland\nsmall thursday searson\nI\n(City) or town)\n(Country)\non\nthe of\nMy present residence is 380 nothanis, Nornich , feru\nluly\n1896\n(Number and street)\n(City or town)\n(County)\n(State)\nMy\npost office address is same as above\nThe\nplace where I took the ship or train which landed me in the United States was Hamburg\nThe ticket on which I came to this country was bought at Grosthi (Month) (City) Germany (Day) (Country) (Year)\nGermany on \"\nThe name of or on came was\nthe ship railroad which I (OVER) SS. President grant 014-8"
}