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e Form 2203 Tothe Repartment of Commeece and TRIPLICATE NATURALIZATION SERVICE [Tobegiven making petti the Declaration) 891 pe No. STATES OF Third. anno Domini anno Domini 1 Fifth. DECLARATION OF INTENTION Sixth. I (Invalid for all purposes seven years after the date hereof) Circuit In the Court I have UNITED STATES OF AMERIOA, SOUTHERN DISTRICT OF ss: of the United States COUNT! or Los Awom.m. Sauthern District of California, Southern Division 3. Mary Climie , aged 48 years, Stend ;rapher do declare on oath that my personal , occupation description is: Color White complexion Fair height 5 feet 8 inches, Seventh. color of eyes Light brown to organized gove weight 130 pounds, color of hair Browm , intention becor other visible distinctive marks None particularly was born in Township ci Wallace, Perth, Ontario, Canada to reside I Eighth. on the 27th day of May anno Domini I 863 : I now reside he the de at 252 E. Grand Vi.ew., Sierra (Give Madre. Calif or town, and number, street, aty State.) this petition, sind I emigrated to the United States of America from Windsor, Canada this Grand Trunk Rv. Co. : my last on the vessel (if the alien arrived otherwise than by vessel, of conveyance or name of transportation company should be given. foreign residence was Listowel,Canada It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign George V, King of Great Attached here prince, potentate, state, or sovereignty, and particularly to myandant and the , of whom I am now a subject; I Britain & Ineland in the arrived at the port of Detroit , on or about the (latterpart TE daty Declaration of State of Mi.chigan of No yember anno Domini I 900 : I am not an anarchist; I am not a polygamist nor a believer in the practice of polygamy: and it is my intention in good faith STAT to become a citizen of the United States of America and to permanently reside therein: Caur So HELP ME GOD. thereof: the information and belie Subscribed and sworn to before me this 1st day of Se ptember anno Domini 191 1. [SEAL] Wm. M. Van like the United States Circit Court. Clerk of By Sonthern District a Deputy California Clerk.

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    "ocrText": "e\nForm 2203\nTothe\nRepartment of Commeece and\nTRIPLICATE\nNATURALIZATION SERVICE\n[Tobegiven making\npetti\nthe Declaration)\n891\npe\nNo.\nSTATES OF\nThird.\nanno Domini\nanno Domini 1\nFifth.\nDECLARATION OF INTENTION\nSixth. I\n(Invalid for all purposes seven years after the date hereof)\nCircuit\nIn the\nCourt\nI have\nUNITED STATES OF AMERIOA,\nSOUTHERN DISTRICT OF\nss:\nof\nthe United States\nCOUNT! or Los Awom.m.\nSauthern District of California, Southern Division\n3.\nMary Climie\n,\naged 48\nyears,\nStend ;rapher\ndo declare on oath that my personal\n,\noccupation\ndescription is: Color\nWhite\ncomplexion\nFair\nheight 5 feet 8 inches,\nSeventh.\ncolor of eyes Light brown\nto organized gove\nweight 130\npounds, color of hair Browm\n,\nintention becor\nother visible distinctive marks\nNone\nparticularly\nwas born in Township ci Wallace, Perth, Ontario, Canada\nto reside\nI\nEighth.\non the\n27th\nday of\nMay\nanno Domini I 863 : I now reside\nhe\nthe\nde\nat\n252 E. Grand Vi.ew., Sierra (Give Madre. Calif or town, and\nnumber, street, aty State.)\nthis petition, sind\nI emigrated to the United States of America from Windsor, Canada\nthis\nGrand Trunk Rv. Co.\n: my last\non the vessel\n(if the alien arrived otherwise than by vessel, of\nconveyance or name of transportation company should be given.\nforeign residence was\nListowel,Canada\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nGeorge V, King of Great\nAttached here\nprince, potentate, state, or sovereignty, and particularly to\nmyandant and the\n, of whom I am now a subject; I\nBritain & Ineland\nin the\narrived at the port of\nDetroit\n, on or about the (latterpart TE daty\nDeclaration of\nState of\nMi.chigan\nof\nNo yember\nanno Domini I 900 : I am not an anarchist; I am not a\npolygamist nor a believer in the practice of polygamy: and it is my intention in good faith\nSTAT\nto become a citizen of the United States of America and to permanently reside therein:\nCaur\nSo HELP ME GOD.\nthereof: the\ninformation and belie\nSubscribed and sworn to before me this\n1st\nday of Se ptember\nanno Domini 191 1.\n[SEAL]\nWm. M. Van like\nthe United States Circit\nCourt.\nClerk of\nBy Sonthern District a Deputy California Clerk."
}