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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5377
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
Epavier
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
}
THEONAGE, (Alien should print typewrite here BLANCHARD original, and name) ; age,
38
years.
Miss
or true, correct
(Give age last birthday)
My present occupation is Weaver
My personal description is: Color, White ; complexion, Sightfur ; height, 5
feet
6
inches;
weight, 156 pounds; color of hair, Brown
; color of eyes,
Blue
other visible
Scars distinctive marks: Right Eye
in
I was born
in It diamase canada
(City or town)
(Country)(
on the
16
day of
Aheal
,
1890
My present residence is
Baltie Minague connecticut
(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
Montreal Canada
on
othil
4
1910
The name of or on came
the ship railroad which I was banadian (Month) Pacifichational (Day) (Year)
My last place was
of foreign residence paid st dlamase commitable togacinthe
(City or town)
wife
I am
married. The name of my
is Amanda Anserecult (Country) She
}
was born at
husband
He
New Bedford mark and now said resides at
Baltic comm,
I am now a subject of and intend to renounce allegiance to King George V of England
(Write name and title of sovereign and country of which now a subject;
I or, arrived if citizen at of a the republic, United write name States of republic immigration only) of St Albans
port
Yumont
(City or town)
, on
(State or territory)
fart 14-8 (Give exact month, 5 day, and year) 1910
(OVER)
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
- e8cd67bea209191b
- 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\n5377\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\nEpavier\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\n}\nTHEONAGE, (Alien should print typewrite here BLANCHARD original, and name) ; age,\n38\nyears.\nMiss\nor true, correct\n(Give age last birthday)\nMy present occupation is Weaver\nMy personal description is: Color, White ; complexion, Sightfur ; height, 5\nfeet\n6\ninches;\nweight, 156 pounds; color of hair, Brown\n; color of eyes,\nBlue\nother visible\nScars distinctive marks: Right Eye\nin\nI was born\nin It diamase canada\n(City or town)\n(Country)(\non the\n16\nday of\nAheal\n,\n1890\nMy present residence is\nBaltie Minague connecticut\n(Number and street)\n(City or town)\n(County) (State)\nThe place where I took the ship or train which landed me in the United States was\nMontreal Canada\non\nothil\n4\n1910\nThe name of or on came\nthe ship railroad which I was banadian (Month) Pacifichational (Day) (Year)\nMy last place was\nof foreign residence paid st dlamase commitable togacinthe\n(City or town)\nwife\nI am\nmarried. The name of my\nis Amanda Anserecult (Country) She\n}\nwas born at\nhusband\nHe\nNew Bedford mark and now said resides at\nBaltic comm,\nI am now a subject of and intend to renounce allegiance to King George V of England\n(Write name and title of sovereign and country of which now a subject;\nI or, arrived if citizen at of a the republic, United write name States of republic immigration only) of St Albans\nport\nYumont\n(City or town)\n, on\n(State or territory)\nfart 14-8 (Give exact month, 5 day, and year) 1910\n(OVER)"
}