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Form 221
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5437
U. S. DEPARTMENT OF LABOR
NOT TO BE FILLED IN BY ALIEN
NATURALIZATION SERVICE
FOR USE OF OFFICIALS SEARCHING IMMI-
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
Mro
Camille Frechette
; age,
41
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
My present occupation is
Farmer
My personal description is: Color, Whitte ;
complexion,
light
; height, 5 feet 8 inches;
634
weight, 172 pounds; color of hair, Dark Brown; color of eyes,
Gray
;
other visible distinctive marks:
NoNe
I was born in
Saint Madeline
(Country) County, Quebee, lanada
(City or town)
on the
15th day of
April
1887
My present residence is 29 South A, Taftville, Norwich
New London Conn.
(Number and street)
(City or town)
(County)
(State)
The place where I took the ship or train which me was
landed in the United States St. Hyacinthe,
Province@ucbee, Canada
, on
September 30th 1915
(Month)
(Day)
(Year)
name of the ship-or railroad on which I came was
Canadian Pacific
My last place of foreign residence was st. Madeline, St. Hyaeinthe County, Country) Quebec Canada
(City or town)
wife
Annie
She
I am
married. The name of my
is
hrusband
}
was born at
He
Rouville
Manyville, County, Quebec, Canada and now resides at Taftville,
Conn.
I
am now a subject of and intend to renounce allegiance to george V. by the grace of god, of of which great
(Write name and title of sovereign and country now a subject;
Britain, beland, and the British Dominious beyond the seas, King, Defender of
if citizen of a republic, write name of republie only)
The Emberor of India.
C
lived at the United States immigration port of
New Port
(City
Vermont
, on
October or town) 1st 1915 77?
(State or territory)
14-8
(Give exact month, day, and year)
(OVER)
Page data
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- Type
- photo
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- e76f7917364f2a63
- 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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Page context
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"ocrText": "Form 221\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5437\nU. S. DEPARTMENT OF LABOR\nNOT TO BE FILLED IN BY ALIEN\nNATURALIZATION SERVICE\nFOR USE OF OFFICIALS SEARCHING IMMI-\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\nMro\nCamille Frechette\n; age,\n41\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nMy present occupation is\nFarmer\nMy personal description is: Color, Whitte ;\ncomplexion,\nlight\n; height, 5 feet 8 inches;\n634\nweight, 172 pounds; color of hair, Dark Brown; color of eyes,\nGray\n;\nother visible distinctive marks:\nNoNe\nI was born in\nSaint Madeline\n(Country) County, Quebee, lanada\n(City or town)\non the\n15th day of\nApril\n1887\nMy present residence is 29 South A, Taftville, Norwich\nNew London Conn.\n(Number and street)\n(City or town)\n(County)\n(State)\nThe place where I took the ship or train which me was\nlanded in the United States St. Hyacinthe,\nProvince@ucbee, Canada\n, on\nSeptember 30th 1915\n(Month)\n(Day)\n(Year)\nname of the ship-or railroad on which I came was\nCanadian Pacific\nMy last place of foreign residence was st. Madeline, St. Hyaeinthe County, Country) Quebec Canada\n(City or town)\nwife\nAnnie\nShe\nI am\nmarried. The name of my\nis\nhrusband\n}\nwas born at\nHe\nRouville\nManyville, County, Quebec, Canada and now resides at Taftville,\nConn.\nI\nam now a subject of and intend to renounce allegiance to george V. by the grace of god, of of which great\n(Write name and title of sovereign and country now a subject;\nBritain, beland, and the British Dominious beyond the seas, King, Defender of\nif citizen of a republic, write name of republie only)\nThe Emberor of India.\nC\nlived at the United States immigration port of\nNew Port\n(City\nVermont\n, on\nOctober or town) 1st 1915 77?\n(State or territory)\n14-8\n(Give exact month, day, and year)\n(OVER)"
}