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Form 22
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5433
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
upper left-hand corner of all copies of
CARD INDEX
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.
augusts (Alien should print da or typéwrite Silva here true, original, Traticarate and correct name) ;
age,
28
years.
Miss
(Give age last birthday)
My present occupation is Screw meachine Operatory
My personal description is: Color, White ; complexion, dark
; height, 5
feet 31/2 inches;
weight, 144 pounds; color of hair, brown
; color of eyes,
brown
;
other visible distinctive marks:
deep - imple in elim
I was born in
Azores
I blands
(City or town)
(Country)
on the
10
day of Jrantre
1900
My present residence is
33 (Number Water street) st (City Stonington town) (County) benn
and
or
(State)
The place where I took the ship train which landed in the United States Pontadelgara
or me was
on Kelinnary (Month) 25- (Day) 1919 (Year)
The name of the ship or railroad on which I came was Bandpis
My
last place of foreign residence was Perblesa (City or town) Beca, Agres (Country)
I
am yes married. The name of my { wife is maria de barm Costa
She
was born at
France do Confersner husband and now resides at Stermington benn He
I am now a subject of and intend to renounce allegiance to
Portical
(Write name and title of sovereign and country of which now a subject;
or, if citizen of a republic, write name of republic only)
,
Roston
I arrived at the United States immigration port of
masschusetts
(City or town)
,
on marco (Give 2 exact 1919 month,
(State or territory)
day, and year)
(OVER)
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
- 74f11520dda1916e
- 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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Document source metadata
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Document source extras
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Page context
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"ocrText": "Form 22\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5433\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\nupper left-hand corner of all copies of\nCARD INDEX\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.\naugusts (Alien should print da or typéwrite Silva here true, original, Traticarate and correct name) ;\nage,\n28\nyears.\nMiss\n(Give age last birthday)\nMy present occupation is Screw meachine Operatory\nMy personal description is: Color, White ; complexion, dark\n; height, 5\nfeet 31/2 inches;\nweight, 144 pounds; color of hair, brown\n; color of eyes,\nbrown\n;\nother visible distinctive marks:\ndeep - imple in elim\nI was born in\nAzores\nI blands\n(City or town)\n(Country)\non the\n10\nday of Jrantre\n1900\nMy present residence is\n33 (Number Water street) st (City Stonington town) (County) benn\nand\nor\n(State)\nThe place where I took the ship train which landed in the United States Pontadelgara\nor me was\non Kelinnary (Month) 25- (Day) 1919 (Year)\nThe name of the ship or railroad on which I came was Bandpis\nMy\nlast place of foreign residence was Perblesa (City or town) Beca, Agres (Country)\nI\nam yes married. The name of my { wife is maria de barm Costa\nShe\nwas born at\nFrance do Confersner husband and now resides at Stermington benn He\nI am now a subject of and intend to renounce allegiance to\nPortical\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)\n,\nRoston\nI arrived at the United States immigration port of\nmasschusetts\n(City or town)\n,\non marco (Give 2 exact 1919 month,\n(State or territory)\nday, and year)\n(OVER)"
}