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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5066
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
NATURALIZATION SERVICE
Place number
33770 In
CARD
RECEIVED
ty
upper left-hand corner of all copies of
INDEX INDFI BOOKS 7 jelant 9/14
declaration, immediately under your
14-60 MAY 24.1927
declaration number.
DISTRICT DIRECTOR OF NATURALIZATION.
MANIFESTS
1119.
OFFICE OF EXAMINER
Utty
EN, CONN.
UE' MADUK
(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.
Antone
My name is
Mrs.
AutonA (Alien should print gr typewrite here true, original, Fedrogyk and correct nama) ;
age,
35
years.
Miss
(Give age last birthday)
Also known as
Antona any other in this country that
name name should be shown here)
I used that name because
The full name of the shown on ticket was
My mother's maiden name was Ludwika Michinska
person my steamship Anton Fedoregyte
My maiden name was (if woman)
My present occcupation is farmer
My personal description is: Color, white; complexion, fair
; height, feet inches;
5 646
weight,
175 pounds; color of hair, brown
; color of eyes,
impon
theybrown
other visible distinctive marks: tattoo rack of right hand by mumb
I was born in
mukawa Poland Russia now Paland
(City or town)
(Country)
on the
15 day of
January
SERVIGA , 189
No
My present residence is
Presine
Nh. Co. Connecticut
My post office address is RFD 3. MAY nonrch Cenn
(Number and street)
(City or town)
(County)
(State)
The place where I took the ship or train which landed me in the United States
antivers
was
Balginem
, on
Settle (Month) aug 28 (Day) 1923 (Year)
The ticket on which I came to this country was bought at Warsaw
(City)
Jey
pbland
(Country)
The name of the ship or railroad on which I came was (OVER) Beelands
10-6-831
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5066\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\nNATURALIZATION SERVICE\nPlace number\n33770 In\nCARD\nRECEIVED\nty\nupper left-hand corner of all copies of\nINDEX INDFI BOOKS 7 jelant 9/14\ndeclaration, immediately under your\n14-60 MAY 24.1927\ndeclaration number.\nDISTRICT DIRECTOR OF NATURALIZATION.\nMANIFESTS\n1119.\nOFFICE OF EXAMINER\nUtty\nEN, CONN.\nUE' MADUK\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.\nAntone\nMy name is\nMrs.\nAutonA (Alien should print gr typewrite here true, original, Fedrogyk and correct nama) ;\nage,\n35\nyears.\nMiss\n(Give age last birthday)\nAlso known as\nAntona any other in this country that\nname name should be shown here)\nI used that name because\nThe full name of the shown on ticket was\nMy mother's maiden name was Ludwika Michinska\nperson my steamship Anton Fedoregyte\nMy maiden name was (if woman)\nMy present occcupation is farmer\nMy personal description is: Color, white; complexion, fair\n; height, feet inches;\n5 646\nweight,\n175 pounds; color of hair, brown\n; color of eyes,\nimpon\ntheybrown\nother visible distinctive marks: tattoo rack of right hand by mumb\nI was born in\nmukawa Poland Russia now Paland\n(City or town)\n(Country)\non the\n15 day of\nJanuary\nSERVIGA , 189\nNo\nMy present residence is\nPresine\nNh. Co. Connecticut\nMy post office address is RFD 3. MAY nonrch Cenn\n(Number and street)\n(City or town)\n(County)\n(State)\nThe place where I took the ship or train which landed me in the United States\nantivers\nwas\nBalginem\n, on\nSettle (Month) aug 28 (Day) 1923 (Year)\nThe ticket on which I came to this country was bought at Warsaw\n(City)\nJey\npbland\n(Country)\nThe name of the ship or railroad on which I came was (OVER) Beelands\n10-6-831"
}