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File numbers 4874 - 5509, 1926-1930

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Form 2213 PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN 4931 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 (NOTE TO CLERK OF COURT.-To guide you in preparing the Declaration: The black face lines on this form contain statements in the regular order as they are to appear on the Declaration of Intention.) I desire to file become a citizen. my - Doclaration of Intention (first paper) to Mr. My name is Mrs. micheal grocki ; age, 49 years. Miss (Alien should print or typewrite here true, original, and correct name) (Give age last birthday) Also known as (If alien has used any other name in this country, that name should be shown here) I used that name because The full name of the person shown on my steamship ticket was micheal Sooci My mother' S maiden name was anna Wytbowska My maiden name was (if woman) My present occcupation is laborer My personal description is: complexion, fair ; height, 5 feet 8 inches; weight, 170 pounds; color of hair, ; color of eyes, darkbrown blank ; other visible distinctive marks: none now I was born in Lomza Russia Boland date or town) (Country) on the 29 day of September ,9 1877 My present residence is 220W.main ist St. norwich Conn. (Number and street) (City or town) (County) (State) My post office address is 220 W. main st The place where I took the ship train which landed in the United States was antwerp, or me Belg Belgium , on may (Montity 16 (Day) 1902 (Year) The ticket on which Icame to this country was bought at Prosthi (City) Germany (Country) The of the ship railroad which I curland name or on came was (OVER) 014-8

Page data

Page
113
Source index
0
Type
photo
Media ID
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Size
unknown

Document data

ID
159596813
Core
doc
Type
document
DTO data 
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Context sent to Scholar

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    "ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4931\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\n(NOTE TO CLERK OF COURT.-To guide you in preparing the Declaration: The black face lines on this form contain statements\nin the regular order as they are to appear on the Declaration of Intention.)\nI desire to file become a citizen.\nmy - Doclaration of Intention (first paper) to\nMr.\nMy name is\nMrs.\nmicheal grocki\n; age,\n49\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nAlso known as\n(If alien has used any other name in this country, that name should be shown here)\nI used that name because\nThe full name of the person shown on my steamship ticket was micheal Sooci\nMy mother' S maiden name was anna Wytbowska\nMy maiden name was (if woman)\nMy present occcupation is laborer\nMy personal description is: complexion, fair\n; height, 5 feet 8 inches;\nweight, 170 pounds; color of hair, ; color of eyes, darkbrown blank\n;\nother visible distinctive marks: none now\nI was born in\nLomza\nRussia Boland\ndate or town)\n(Country)\non the 29\nday of September ,9 1877\nMy present residence is 220W.main ist St. norwich Conn.\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post office address is 220 W. main st\nThe place where I took the ship train which landed in the United States was antwerp,\nor me\nBelg Belgium\n, on may (Montity 16 (Day) 1902 (Year)\nThe ticket on which Icame to this country was bought at Prosthi (City) Germany (Country)\nThe of the ship railroad which I curland\nname or on came was\n(OVER)\n014-8"
}