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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5139
U. S. DEPARTMENT OF LABOR
NOT TO BE FILLED IN BY ALIEN
NATURALIZATION SERVICE
FOR USE OF OFFICIALS SEARCHING IMMI-
GRATION RECORDS
CLERK OF COURT:
RECORDS EXAMINED
Place number
in
upper left-hand corner of all copies of
CARD INDEX
declaration, immediately under your
INDEX BOOKS
declaration number.
DISTRICT DIRECTOR OF NATURALIZATION
MANIFESTS
.
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mf.
My name is
Mrs.
Emily Ellen, Le Cocq,
; age,
55
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
My present occupation is
The Salvation Army
5-1/2
My personal description is: Color, White
; complexion,
Fair
; height, 5
feet
weight, 146
pounds; color of hair,
Dark
darkbown
color of eyes,
Blue
;
other visible distinctive marks:
Scar on forchead
I was born in
Gaspe,
Canada.
(City or town)
(Country)
e
on the 13th
day of
January
, 872
My present residence is
27
State St,
New London,
Conn.
(Number and street)
(City or town)
(County)
(State)
The place where I took the ship or train which landed me in the United States was Toronto, Canada
on October
12th, 1908.
(Month)
(Day)
(Year)
The name of the ship or railroad on which I came was Canadian Pacific Railroad
My last place of foreign residence was
Toronto,
Canada.
(City or town)
Cliam
(Country)
She
I am Marriedarried. The name of my
is
John, W In
was born at
husband
He
St Heliers, Jersey, channe and now Islands resides at Now lendeni, Conn. said 27
statestrut.
I am now a subject of and intend to renounce allegiance to Dominion of canada, Parliment
(Write name and title of sovereign and country of which now a subject;
King George V
or, if citizen of a republic, write name of republic only)
I arrived at the United States immigration port of Niagara Falls, NXXX
(City or town)
N.Y.
on Oct 12th, 1908
,
(State or territory)
14-8
(Give exact month, day, and year)
(OVER)
Page data
- Page
- 530
- Source index
- 0
- Type
- photo
- Media ID
- f86e822fdbb1f877
- Size
- unknown
Document data
- ID
- 159596813
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
Document identity
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Document source metadata
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Page context
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5139\nU. S. DEPARTMENT OF LABOR\nNOT TO BE FILLED IN BY ALIEN\nNATURALIZATION SERVICE\nFOR USE OF OFFICIALS SEARCHING IMMI-\nGRATION RECORDS\nCLERK OF COURT:\nRECORDS EXAMINED\nPlace number\nin\nupper left-hand corner of all copies of\nCARD INDEX\ndeclaration, immediately under your\nINDEX BOOKS\ndeclaration number.\nDISTRICT DIRECTOR OF NATURALIZATION\nMANIFESTS\n.\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMf.\nMy name is\nMrs.\nEmily Ellen, Le Cocq,\n; age,\n55\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nMy present occupation is\nThe Salvation Army\n5-1/2\nMy personal description is: Color, White\n; complexion,\nFair\n; height, 5\nfeet\nweight, 146\npounds; color of hair,\nDark\ndarkbown\ncolor of eyes,\nBlue\n;\nother visible distinctive marks:\nScar on forchead\nI was born in\nGaspe,\nCanada.\n(City or town)\n(Country)\ne\non the 13th\nday of\nJanuary\n, 872\nMy present residence is\n27\nState St,\nNew London,\nConn.\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 was Toronto, Canada\non October\n12th, 1908.\n(Month)\n(Day)\n(Year)\nThe name of the ship or railroad on which I came was Canadian Pacific Railroad\nMy last place of foreign residence was\nToronto,\nCanada.\n(City or town)\nCliam\n(Country)\nShe\nI am Marriedarried. The name of my\nis\nJohn, W In\nwas born at\nhusband\nHe\nSt Heliers, Jersey, channe and now Islands resides at Now lendeni, Conn. said 27\nstatestrut.\nI am now a subject of and intend to renounce allegiance to Dominion of canada, Parliment\n(Write name and title of sovereign and country of which now a subject;\nKing George V\nor, if citizen of a republic, write name of republic only)\nI arrived at the United States immigration port of Niagara Falls, NXXX\n(City or town)\nN.Y.\non Oct 12th, 1908\n,\n(State or territory)\n14-8\n(Give exact month, day, and year)\n(OVER)"
}