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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4907
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.
oseph pacanision in English
Miss
Security (Alien/shonlo print typewrite here true original, in and correct taliani name) age, 43y (Give last birthday)
or
age
Also known as
Sinsepper (If yacaruse
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 tieket was
My mother S maiden name was
My maiden name was (if woman)
My present occcupation is
laborer
My personal description is: Color, white ; complexion, fair
; height, 5 feet 43 inches;
weight, 132 pounds; color of hair, dark brown ; color of eyes, blue
4
;
other visible distinctive marks: Scar at resprightforthing
I was born
Pros. Foggia
in (City or town) that (Country)
on the
17
day of Sept.
1883
My present residence is nonwich (Number and street) Conn. (City 458 or town) north (County) main Street (State)
My post office address is 458 north main it Norwrich Is Can
Enapars,
73elguim The place where I took the train ship or train Belg which to landed 4. in both , on the United 9thdday States (Month) was of family april oggia (Day) 1904 to (Year) of on the geril
me
flux
landediqut
1904
The ticket on which I came to this country was bought at
The name of the ship or railroad on which I came was
(OVER)
Zealand (City) Beeland (Country) c14-8
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Document data
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4907\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.\noseph pacanision in English\nMiss\nSecurity (Alien/shonlo print typewrite here true original, in and correct taliani name) age, 43y (Give last birthday)\nor\nage\nAlso known as\nSinsepper (If yacaruse\nalien 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 tieket was\nMy mother S maiden name was\nMy maiden name was (if woman)\nMy present occcupation is\nlaborer\nMy personal description is: Color, white ; complexion, fair\n; height, 5 feet 43 inches;\nweight, 132 pounds; color of hair, dark brown ; color of eyes, blue\n4\n;\nother visible distinctive marks: Scar at resprightforthing\nI was born\nPros. Foggia\nin (City or town) that (Country)\non the\n17\nday of Sept.\n1883\nMy present residence is nonwich (Number and street) Conn. (City 458 or town) north (County) main Street (State)\nMy post office address is 458 north main it Norwrich Is Can\nEnapars,\n73elguim The place where I took the train ship or train Belg which to landed 4. in both , on the United 9thdday States (Month) was of family april oggia (Day) 1904 to (Year) of on the geril\nme\nflux\nlandediqut\n1904\nThe ticket on which I came to this country was bought at\nThe name of the ship or railroad on which I came was\n(OVER)\nZealand (City) Beeland (Country) c14-8"
}