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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5506.
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:
53987
RECORDS EXAMINED
ATURALIZATION SERVIOZ
Place number
in
RECAIVED
upper left-hand corner of all copies of
CARD INDEX
declaration, immediately under your
INDEX BOOKS
DEC 14 1928
declaration number.
OFFICE OF RXAMINER
DISTRICT DIRECTOR OF NATURALIZATION
MANIFESTS
NEW BAVIN CONN.
departmen
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
Albert (Alien should print or typewrite Joly here
36
; age,
years.
Miss
true, original, and correct name)
(Give age last birthday)
My present occupation is
Labover (sawmill)
My personal description is: Color, white: ; complexion, dark
; height,
5 feet 8
weight, 160 pounds; color of hair, black
; color of eyes, the charel
other visible distinctive marks:
I was born in
St geande
(City town) matha
or
on the
4
day of
november
1 892
Consented (Country)
,
My present residence is
(Number and street)
Chesterfield
(City or town) newhonding (County) participant (State) Conn.
The place where I took the ship or train which landed me in the United States was
montreal M.G.B. august (Month)
, on
12
1927
The name or on came was
of the ship railroad which I Janetters Pacification (Day) (Year)
My last place of foreign residence was
montreal
Canada
(City or town)
(Çountry)
was
wife
wife is dead
She
I am married. The name of my
is
husband
He
}
was born at
, and now resides at
I am now a subject of and intend to renounce allegiance to
Canada
mineter (Write name and title of sovereign country of of
and which now a subject;
or, if citizen of a republic, write name of republic only)
malone
I arrived at the United States immigration port of
(City or town)
new (State tervitory) York
, on
or
augustic 14-8 (Give exact month, day, and 1927 year)
(OVER)
O/A IBSUED
DEC 9 1928
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Document data
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- Core
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- Type
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DTO data
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5506.\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:\n53987\nRECORDS EXAMINED\nATURALIZATION SERVIOZ\nPlace number\nin\nRECAIVED\nupper left-hand corner of all copies of\nCARD INDEX\ndeclaration, immediately under your\nINDEX BOOKS\nDEC 14 1928\ndeclaration number.\nOFFICE OF RXAMINER\nDISTRICT DIRECTOR OF NATURALIZATION\nMANIFESTS\nNEW BAVIN CONN.\ndepartmen\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nAlbert (Alien should print or typewrite Joly here\n36\n; age,\nyears.\nMiss\ntrue, original, and correct name)\n(Give age last birthday)\nMy present occupation is\nLabover (sawmill)\nMy personal description is: Color, white: ; complexion, dark\n; height,\n5 feet 8\nweight, 160 pounds; color of hair, black\n; color of eyes, the charel\nother visible distinctive marks:\nI was born in\nSt geande\n(City town) matha\nor\non the\n4\nday of\nnovember\n1 892\nConsented (Country)\n,\nMy present residence is\n(Number and street)\nChesterfield\n(City or town) newhonding (County) participant (State) Conn.\nThe place where I took the ship or train which landed me in the United States was\nmontreal M.G.B. august (Month)\n, on\n12\n1927\nThe name or on came was\nof the ship railroad which I Janetters Pacification (Day) (Year)\nMy last place of foreign residence was\nmontreal\nCanada\n(City or town)\n(Çountry)\nwas\nwife\nwife is dead\nShe\nI am married. The name of my\nis\nhusband\nHe\n}\nwas born at\n, and now resides at\nI am now a subject of and intend to renounce allegiance to\nCanada\nmineter (Write name and title of sovereign country of of\nand which now a subject;\nor, if citizen of a republic, write name of republic only)\nmalone\nI arrived at the United States immigration port of\n(City or town)\nnew (State tervitory) York\n, on\nor\naugustic 14-8 (Give exact month, day, and 1927 year)\n(OVER)\nO/A IBSUED\nDEC 9 1928"
}