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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5159
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
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.
Mr.
My name is
Mrs.
Francisek Dembek ;
rancise (Alien/should print or typewrite here true, original, and correct name)
age,
39
years.
(Give age last birthday)
My present occupation Miss is is: farmer Color, white, complexion, dark
My
personal
description
; height, 5 feet 9 inches;
weight, 175 pounds; color of hair, brown ;
color of eyes, brown
;
Pockmarkson
other
I
was born in Drikawola Russia, nonepaland (Country)
visible distinctive marks: fagranat end or right thumb
on the 2nd day of
(City or town)
april
1888
My present residence is
Lisbon Connecticut
(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 gremen
Bermany
, on February (Month) (Day)
1910
which I Daremstat
(Year)
The name of the ship or railroad on came was
My last place of foreign residence was (City or town) Russia (Country)
Schietowa,
I am
married. The name of my
{
wife
}
is Maryiannang
She
was born at
husband
He
said Scpirtowa
,
and now resides /at
I am now a subject of and intend to renounce allegiance to
Poland
(Write name and title of sovereign and country of which now a subject;
or, if citizen of a republic, write name of republic only)
I arrived at the United States immigration port of
Newyork
march14,
(City or town)
Asy (State of
, on 1910
territory)
14-28
(Give exact month, day, and year)
(OVER)
Page data
- Page
- 570
- Source index
- 0
- Type
- photo
- Media ID
- eacbd3e90239fb1a
- 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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Document source extras
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Page context
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5159\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\nupper left-hand corner of all copies of\nCARD INDEX\ndeclaration, immediately under your\nINDEX BOOKS\ndeclaration number.\nDISTRICT DIRECTOR OF NATURALIZATION\nMANIFESTS\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nFrancisek Dembek ;\nrancise (Alien/should print or typewrite here true, original, and correct name)\nage,\n39\nyears.\n(Give age last birthday)\nMy present occupation Miss is is: farmer Color, white, complexion, dark\nMy\npersonal\ndescription\n; height, 5 feet 9 inches;\nweight, 175 pounds; color of hair, brown ;\ncolor of eyes, brown\n;\nPockmarkson\nother\nI\nwas born in Drikawola Russia, nonepaland (Country)\nvisible distinctive marks: fagranat end or right thumb\non the 2nd day of\n(City or town)\napril\n1888\nMy present residence is\nLisbon Connecticut\n(Number and street)\n(City or town)\n(County)\n(State)\nThe place\nwhere I took the ship or train which landed me in the United States was gremen\nBermany\n, on February (Month) (Day)\n1910\nwhich I Daremstat\n(Year)\nThe name of the ship or railroad on came was\nMy last place of foreign residence was (City or town) Russia (Country)\nSchietowa,\nI am\nmarried. The name of my\n{\nwife\n}\nis Maryiannang\nShe\nwas born at\nhusband\nHe\nsaid Scpirtowa\n,\nand now resides /at\nI am now a subject of and intend to renounce allegiance to\nPoland\n(Write name and title of sovereign and country of which now a subject;\nor, if citizen of a republic, write name of republic only)\nI arrived at the United States immigration port of\nNewyork\nmarch14,\n(City or town)\nAsy (State of\n, on 1910\nterritory)\n14-28\n(Give exact month, day, and year)\n(OVER)"
}