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    "localId": "159596813",
    "label": "File numbers 4874 - 5509, 1926-1930",
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    "contentType": "document",
    "title": "File numbers 4874 - 5509, 1926-1930",
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        "Naturalization Records of Non-Federal Courts in Connecticut",
        "Applications for Declaration of Intention"
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    "seq": 657,
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    "ocrText": "Form 2213\nFACTS FOR DECLARATION OF INTENTION\n5203\nU. S. DEPARTMENT OF LABOR\nNATURALIZATION SERVICE\nNOTE.-/ copy of this form will be furnished by the clerk of the court, the Chief Naturalization Examiner, or the\npublic-school teacher to each applicant for a declaration of intention, so that he can at his leisure fill in the answers to\nthe questions. After being filled out the form is to be returned to the clerk, to be used by him in properly filling out the\ndeclaration. Care should be used to state as near as can be remembered the day, month, and year of arrival, as well as\nthe name of the vessel on which the alien emigrated to this country.\nTO THE APPLICANT.-Th fee of one dollar required by law for the declaration, must be paid to the clerk of the\ncourt before he commences to fill out the declaration of intention. No fee is chargeable for this blank, and none\nshould be paid for assistance in filling it out, as the Naturalization Examiner or the public-school teacher will help you\nfree of charge.\nMy name is Carola Leonie Agnes Ernst\nAge:\n43\nyears.\n(Alien should state here his true, original, and correct name in full.)\n(Give age at last birthday.)\nAlso known as\nCarola Leonie Ernst\n(If alien has used any other name in this country, that name should be shown on line immediately above.)\nOccupation:\nCollege Professor\nColor:\nWhite\nComplexion: Fair\nHeight:\nFive\nfeet\nfive\ninches. Weight:\n1.32\npounds.\nColor of hair: brown\nColor of eyes:\ng-p-ey\nOther visible distinctive marks: none\n(If no visible distinctive marks, so state.)\nWhere born: Lodelinsart\n,\nBolgium\n(City or town.)\n(Country.)\nDate of birth:\nNovember\n,\n25\n,\n1-884\n(Month.)\n(Day.)\n(Year.)\nPresent residence:\nConnecticut Co} lege, New Landon, Connecticut\n(Number and street.)\n(City or town.)\n(State, Territory, or District.)\nEmigrated from:\nRotterdam\n,\nHollend\n(Place where alien got on ship or train to come to the United States.)\n(Country.)\nName of vessel:\nNew Amsterden\n(If the alien arrived otherwise than by vessel, the character of conveyance or name of transportation company should be given.)\nLast place of foreign residence:\nCharleroi\n,\nBelgium\n(City or town.)\n(Country.)\n*I am not married; bename of my wife is\n, shown\nborn at\n; and now resides at\nI am now a subject of and intend to renounce allegiance to Alberty King of\nthe Belgians (Beloium)\n(Write name and title of sovereign and country of which now a subject; or if citizen of a Republic, write name of Republiconly.)\nI arrived at the port of. Hoboken\n,\nNew Jersey\n(City or town.)\n(State or Territory.)\non OT about December\n,\n5\n,\n1915\n(Month.)\n(Day.)\n(Year.)\n* NOTE TO CLERK OF COURT.-The two lines indicated by the * contain information which is provided for by blanks on the latest\ndeclaration of intention form; until such time as you may be supplied with forms containing these blank spaces the information called\nfor herein should be inserted immediately ABOVE the twelfth line, which begins It is my bona fide intention,' etc., as requested in\ncircular letter of January 5, 1916.\n14-8"
}