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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5399
U. S. DEPARTMENT OF LABOR
NOT TO BE FILLED IN BY ALIEN
FOR USE OF OFFICIALS SEARCHING IMMI-
NATURALIZATION SERVICE
GRATION RECORDS
NATURALIZA TION SERVION
CLERK OF COURT:
RECALVER
RECORDS EXAMINED
48498
Place number
in
CARD INDEX
JUL 5 1928
upper left-hand corner of all copies of
INDEX BOOKS
DISTRICI DIRECTOR
declaration, immediately under your
BOSTON MASS,
declaration number.
DEPARTIMENT OF LABOR
ZATION
DISTRICT DIRECTOR OF NATURALIZATION
MANIFESTS
I desire to
Samul file my Declaration of Intention (first paper) to become a citizen.
1
1929
Mr.
OF OONY
of
My name is
Mrs.
/
Shuncel (Alien should print Vieder typewrite here true, ferusalusing original, and OFFICE
agey DN, u 37
V
years.
Miss
or correct name)
(Give age last birthday)
My
present occupation is Edge Trimewere shows.
My personal description is: Color, white ; complexion, medium. height, 5 feet 187 inches;
weight, 182 pounds; color of hair, Bractice
; color of eyes, Black Brown
other visible distinctive marks: semon lefts
I
was born in (City town)
Chernawehez
PAland
Septembarch
or
(Country)
on the
15 day of
, 1891
My present residence is
35 Fairmount St, worwich, Come,
(Number and street)
(City or town)
(County)
(State)
The place
Polaud
where I took the ship or train which landed me in the United States was at Dauging
on
april 16 , f 1928
(Month)
(Day)
(Year)
The
name of the ship or railroad on which I came was S.S. Estoria, Baltic Lion
My
last place of foreign residence was (City town)
Palaud
or
(Country)
wife
I am
name
is
husband
, and now
resides at Genusurely Boloud
Leja gerozolimaka He She
was born at
Raunetty hitower Polouid
I am now a subject of and intend to renounce allegiance to
Poland
(Write name and title of sovereign and country of which now a subject;
Republic of Poland
or, if citizen of a republic, write name of republic only)
I arrived at the United States immigration port of
new your (City or town) (Brookly)
n.y (State
,
or territory)
on april 14-8 (Give exact 29, month, day, 1988 and year)
(OVER)
O/A ISSUED
JUL 25 1928
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
- 661b4425ac779f87
- Size
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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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Page context
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5399\nU. S. DEPARTMENT OF LABOR\nNOT TO BE FILLED IN BY ALIEN\nFOR USE OF OFFICIALS SEARCHING IMMI-\nNATURALIZATION SERVICE\nGRATION RECORDS\nNATURALIZA TION SERVION\nCLERK OF COURT:\nRECALVER\nRECORDS EXAMINED\n48498\nPlace number\nin\nCARD INDEX\nJUL 5 1928\nupper left-hand corner of all copies of\nINDEX BOOKS\nDISTRICI DIRECTOR\ndeclaration, immediately under your\nBOSTON MASS,\ndeclaration number.\nDEPARTIMENT OF LABOR\nZATION\nDISTRICT DIRECTOR OF NATURALIZATION\nMANIFESTS\nI desire to\nSamul file my Declaration of Intention (first paper) to become a citizen.\n1\n1929\nMr.\nOF OONY\nof\nMy name is\nMrs.\n/\nShuncel (Alien should print Vieder typewrite here true, ferusalusing original, and OFFICE\nagey DN, u 37\nV\nyears.\nMiss\nor correct name)\n(Give age last birthday)\nMy\npresent occupation is Edge Trimewere shows.\nMy personal description is: Color, white ; complexion, medium. height, 5 feet 187 inches;\nweight, 182 pounds; color of hair, Bractice\n; color of eyes, Black Brown\nother visible distinctive marks: semon lefts\nI\nwas born in (City town)\nChernawehez\nPAland\nSeptembarch\nor\n(Country)\non the\n15 day of\n, 1891\nMy present residence is\n35 Fairmount St, worwich, Come,\n(Number and street)\n(City or town)\n(County)\n(State)\nThe place\nPolaud\nwhere I took the ship or train which landed me in the United States was at Dauging\non\napril 16 , f 1928\n(Month)\n(Day)\n(Year)\nThe\nname of the ship or railroad on which I came was S.S. Estoria, Baltic Lion\nMy\nlast place of foreign residence was (City town)\nPalaud\nor\n(Country)\nwife\nI am\nname\nis\nhusband\n, and now\nresides at Genusurely Boloud\nLeja gerozolimaka He She\nwas born at\nRaunetty hitower Polouid\nI am now a subject of and intend to renounce allegiance to\nPoland\n(Write name and title of sovereign and country of which now a subject;\nRepublic of Poland\nor, if citizen of a republic, write name of republic only)\nI arrived at the United States immigration port of\nnew your (City or town) (Brookly)\nn.y (State\n,\nor territory)\non april 14-8 (Give exact 29, month, day, 1988 and year)\n(OVER)\nO/A ISSUED\nJUL 25 1928"
}