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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5224
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.
Mr.
My name is
Mrs.
|
Katarzyna (Alien should print or typewrite here true, original, Leyko and correct name) ; age,
34
years.
(Give age last birthday)
Miss
My present occupation is
House keeper wife
My personal description is: Color, white, ; complexion, fair ; height, 5 feet 414 inches;
weight, 122 pounds; color of hair, brown
color of blue
other visible distinctive marks Lift thumbneil ; eyes, of
I
was born in Ottynia (City gr-town) Austria now Poland. (Country)
left fortfinger
on the 25 day of
November
, 1 1893
My present residence is 485 north main It Norwich 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
Hamburg
germany
on December 5th 1911
,
(Day)
(Year)
The name of the ship or railroad said on which I came was KaisefineMengutia (Month) Victoria
My last place of foreign résidence was
A wife City or town) Poland (Country)
Attynical
husband
Poland Midec Polandia now said resides at 485 North main It,
is mateus
She
I am
married. The name of my
was born at
He
I am now a subject of and intend to renounce
allegiance to the (Write Republic name and title of sovereign and of country Poland of which now a subject;
if citizen of write name of
I
or, arrived at a the republic, United States republic immigration only) port of New York (City City or town)
New (State or
York
, on December 5, 1911
territory)
14-8
(Give exact month, day, and year)
(OVER)
Page data
- Page
- 699
- Source index
- 0
- Type
- photo
- Media ID
- 833a2bf86eab90c5
- 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\n5224\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\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\n|\nKatarzyna (Alien should print or typewrite here true, original, Leyko and correct name) ; age,\n34\nyears.\n(Give age last birthday)\nMiss\nMy present occupation is\nHouse keeper wife\nMy personal description is: Color, white, ; complexion, fair ; height, 5 feet 414 inches;\nweight, 122 pounds; color of hair, brown\ncolor of blue\nother visible distinctive marks Lift thumbneil ; eyes, of\nI\nwas born in Ottynia (City gr-town) Austria now Poland. (Country)\nleft fortfinger\non the 25 day of\nNovember\n, 1 1893\nMy present residence is 485 north main It Norwich Conn.\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\nHamburg\ngermany\non December 5th 1911\n,\n(Day)\n(Year)\nThe name of the ship or railroad said on which I came was KaisefineMengutia (Month) Victoria\nMy last place of foreign résidence was\nA wife City or town) Poland (Country)\nAttynical\nhusband\nPoland Midec Polandia now said resides at 485 North main It,\nis mateus\nShe\nI am\nmarried. The name of my\nwas born at\nHe\nI am now a subject of and intend to renounce\nallegiance to the (Write Republic name and title of sovereign and of country Poland of which now a subject;\nif citizen of write name of\nI\nor, arrived at a the republic, United States republic immigration only) port of New York (City City or town)\nNew (State or\nYork\n, on December 5, 1911\nterritory)\n14-8\n(Give exact month, day, and year)\n(OVER)"
}