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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5393
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 become a citizen.
to file my Declaration of Intention (first Hilgrez paper) Cooper
Mr.
My name is
Mrs.
Miss
/
Charlesteary (Alien should print or typexfrite here true, Holgree originay, and
; age,
34
years.
correct name)
(Give age last birthday)
My present occupation is
wanted
My personal description is: Color, african ; complexion
dark
; height, 5 feet 73/4 inches;
weight, 140 pounds; color of hair, darkbrown ; color of eyes, darkbrown
I
was born in Somerset, Bermanda
other visible distinctive marks: Scoronfordead
5th of
(City or town)
(Country)
on the
day
march
1 894
,
My present
residence is (Number and street) Hill, (City/or town) New London, (County) (State) Corn.
instory
The States was
place where I took the ship or train which landed me in the on United
Bermuda
The name or on came was
of the ship railroad which I
Kribitis
(Month)
(Day)
(Year)
My was
last place of foreign residence said Somerset the
(City or town)
wife
I am
is
Claraclizates
She
married. The name of my
was born at
husband
He
I Providence subject of and intend R. I allegiance f-, and now to resides George at said History Hill
am now a to renounce
(Write name and title of sovereign and country of which subject;
now a
or, if citizen of a republic, write name of republic only)
I arrived at the United States immigration port of
Tensfork
or
Registration
(CAT OR town)
(State territory)
(OVER) , on 14-8 Give exact month, day, and year)
,1917
Page data
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- Source index
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- Type
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Document data
- ID
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- Core
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- Type
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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\n5393\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 become a citizen.\nto file my Declaration of Intention (first Hilgrez paper) Cooper\nMr.\nMy name is\nMrs.\nMiss\n/\nCharlesteary (Alien should print or typexfrite here true, Holgree originay, and\n; age,\n34\nyears.\ncorrect name)\n(Give age last birthday)\nMy present occupation is\nwanted\nMy personal description is: Color, african ; complexion\ndark\n; height, 5 feet 73/4 inches;\nweight, 140 pounds; color of hair, darkbrown ; color of eyes, darkbrown\nI\nwas born in Somerset, Bermanda\nother visible distinctive marks: Scoronfordead\n5th of\n(City or town)\n(Country)\non the\nday\nmarch\n1 894\n,\nMy present\nresidence is (Number and street) Hill, (City/or town) New London, (County) (State) Corn.\ninstory\nThe States was\nplace where I took the ship or train which landed me in the on United\nBermuda\nThe name or on came was\nof the ship railroad which I\nKribitis\n(Month)\n(Day)\n(Year)\nMy was\nlast place of foreign residence said Somerset the\n(City or town)\nwife\nI am\nis\nClaraclizates\nShe\nmarried. The name of my\nwas born at\nhusband\nHe\nI Providence subject of and intend R. I allegiance f-, and now to resides George at said History Hill\nam now a to renounce\n(Write name and title of sovereign and country of which subject;\nnow a\nor, if citizen of a republic, write name of republic only)\nI arrived at the United States immigration port of\nTensfork\nor\nRegistration\n(CAT OR town)\n(State territory)\n(OVER) , on 14-8 Give exact month, day, and year)\n,1917"
}