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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5337
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
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
Bronislaw (Alien should print typewrite Ukleja here true, riginal,
; age,
37
years.
Miss
or and correct name)
(Give age last birthday)
My present occupation
is Clerk in store
3
My personal description is: Color, white ; complexion, dark
; height, 5 feet 4 inches;
weight, 144
pounds; color of hair, brown ; color of eyes, brown
;
Scars
other visible distinctive marks: Scare left eye,
I was born in
austrial now Paland (Country)
(City or town)
11
on the
day of november
1890
My present residence is 16 Sherman Street norwich new London Coun
(Number and street)
(City or town)
(County)
(State)
The or me was
place where I took the ship train which landed in the United States Bremen Germany
, on
November
/
1906
(Month)
(Day)
(Year)
The name of the ship or railroad on which I came was Bremen
My last place of foreign residence
said was (City of town)
Kupienin
Poland
(Country)
wife
I am
is said Rosie Ulklyja
She
married. The name of my
was born at
huaband
felesnia, austria
, and now resides
at 16 Sheman St., norwich Conn
I am now a subject of and intend to renounce allegiance to
Paland (Sepublic)
(Write name and title of sovereign and country of which now a subject;
or, if citizen of a republic, write name of republic only)
Jeleina
I arrived at the United States immigration port of
Hubeaken (City town) new York
or
Rey new (State or territory)
Jerry
,
on november 13, 1906
14-8
(Give exact month, day, and year)
(OVER)
Page data
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- Type
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- Media ID
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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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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5337\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\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nBronislaw (Alien should print typewrite Ukleja here true, riginal,\n; age,\n37\nyears.\nMiss\nor and correct name)\n(Give age last birthday)\nMy present occupation\nis Clerk in store\n3\nMy personal description is: Color, white ; complexion, dark\n; height, 5 feet 4 inches;\nweight, 144\npounds; color of hair, brown ; color of eyes, brown\n;\nScars\nother visible distinctive marks: Scare left eye,\nI was born in\naustrial now Paland (Country)\n(City or town)\n11\non the\nday of november\n1890\nMy present residence is 16 Sherman Street norwich new London Coun\n(Number and street)\n(City or town)\n(County)\n(State)\nThe or me was\nplace where I took the ship train which landed in the United States Bremen Germany\n, on\nNovember\n/\n1906\n(Month)\n(Day)\n(Year)\nThe name of the ship or railroad on which I came was Bremen\nMy last place of foreign residence\nsaid was (City of town)\nKupienin\nPoland\n(Country)\nwife\nI am\nis said Rosie Ulklyja\nShe\nmarried. The name of my\nwas born at\nhuaband\nfelesnia, austria\n, and now resides\nat 16 Sheman St., norwich Conn\nI am now a subject of and intend to renounce allegiance to\nPaland (Sepublic)\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)\nJeleina\nI arrived at the United States immigration port of\nHubeaken (City town) new York\nor\nRey new (State or territory)\nJerry\n,\non november 13, 1906\n14-8\n(Give exact month, day, and year)\n(OVER)"
}