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Form 2213 PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN 4989 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. John Dabrowski faw ; age, 39 40 years. Miss (Alien should print or typewrite here true, original, and correct name) (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 wass My mother's maiden name was My maiden name was (if woman) My present occcupation is Farmer My personal description is: Color, darkwhite ; complexion, dark ; height, 5 feet H inches; 1012 weight, 165 pounds; color of hair, brown dark ; color of eyes, brown ; other visible distinctive marks: none I was born in W. now (City or town) (Country) My present residence is RFD4 taken Colchester newhondon Conn on the 15 day of august , 1887 (Number and street) (City or town) (County) My post office address is Colchester (State) RID4 Conn The place where I took the ship or train which landed me in the United States was on march 27 1906 , (Month) (Day) (Year) The ticket OII which I came to this country was bought at The of the ship railroad which I came was Bey walders . (City) (Country) name or on (OVER) 614-8

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    "ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4989\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.\nJohn Dabrowski\nfaw\n; age,\n39 40\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\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 name of the person shown on my steamship ticket wass\nMy mother's maiden name was\nMy maiden name was (if woman)\nMy present occcupation is Farmer\nMy personal description is: Color, darkwhite ; complexion, dark ; height, 5 feet H inches;\n1012\nweight, 165 pounds; color of hair, brown\ndark\n; color of eyes, brown\n;\nother visible distinctive marks: none\nI was\nborn in W. now\n(City or town)\n(Country)\nMy present residence is RFD4 taken Colchester newhondon Conn\non the 15\nday of\naugust\n, 1887\n(Number and street)\n(City or town)\n(County)\nMy post office address is\nColchester\n(State)\nRID4 Conn\nThe place where I took the ship or train which landed me in the United States was\non march\n27\n1906\n,\n(Month)\n(Day)\n(Year)\nThe ticket OII which I came to this country was bought at\nThe of the ship railroad which I came was Bey walders . (City) (Country)\nname or on\n(OVER)\n614-8"
}