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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4963
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
Mrs.
ALEX SHULGA
; age,
4039 years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
Also known as
No OTHER NAME
(If
alien has used any other name in this country, that name should be shown here)
I used that name because
No
The full name of the person shown on my steamship ticket was,
My nother's maiden nante was
My maiden nullo (II woman)
My present
occcupation is BookBACK H.S.PiNisHing Comp.
My personal description is: Color, white ; complexion, fair ; height,
5 feet 6 inches;
weight, 225 pounds; color of hair, CANY color of
other visible distinctive marks: Scar inright ; systabrow eyes, gray
;
I was born in
BAGBHT, Russia now POLANd
(Clitge or town)
(Country)
on the 17 day of
JUNYE
1 887
My residence is 528 NORTH MAIN ST. NORWICH NEWLONDON CONN.
present
(Number and street)
(City or town)
(County)
(State)
My post office address is 528 NoRTH MAIN ST. NORWICH CONN.
The place where I took the ship train which landed me the United States was HAMBURG Jor.
or in
, on
JANUARY
13
1913
(Month)
(Day)
(Year)
The ticket on which I came to this country was bought at
(City)
(Country)
The name of the ship or railroad on which I came was
BRONZ
(OVER)
c14-8
Page data
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- Source index
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Document data
- ID
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- Core
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- Type
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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\n4963\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\nMrs.\nALEX SHULGA\n; age,\n4039 years.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nAlso known as\nNo OTHER NAME\n(If\nalien has used any other name in this country, that name should be shown here)\nI used that name because\nNo\nThe full name of the person shown on my steamship ticket was,\nMy nother's maiden nante was\nMy maiden nullo (II woman)\nMy present\nocccupation is BookBACK H.S.PiNisHing Comp.\nMy personal description is: Color, white ; complexion, fair ; height,\n5 feet 6 inches;\nweight, 225 pounds; color of hair, CANY color of\nother visible distinctive marks: Scar inright ; systabrow eyes, gray\n;\nI was born in\nBAGBHT, Russia now POLANd\n(Clitge or town)\n(Country)\non the 17 day of\nJUNYE\n1 887\nMy residence is 528 NORTH MAIN ST. NORWICH NEWLONDON CONN.\npresent\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post office address is 528 NoRTH MAIN ST. NORWICH CONN.\nThe place where I took the ship train which landed me the United States was HAMBURG Jor.\nor in\n, on\nJANUARY\n13\n1913\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\n(City)\n(Country)\nThe name of the ship or railroad on which I came was\nBRONZ\n(OVER)\nc14-8"
}