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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4975
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 file my Declaration
to
Mr.
Alexandra of Intention (first Gaska paper) to become a citizen Gaska
Mrs. het
aleksandra
My name is
Mrs.
; age,
5
45 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 sho on my steamship ticket was
My mother
My maide namo was (if woman).
My present occcupation is
house-wife
3
My personal description is: Color, white
; complexion, fair
; height,
5
feet
inches;
weight, 145 pounds; color of hair, dark brown ; color of eyes, brown gray
;
other visible distinctive marks:
I was born in
Stanislawowo
Russia, now
Poland
(City or town)
(Country)
on the
day of
April
1881
, ,1
My present residence is to
40 Eastern Ave , New London , Conn.
(Number and street)
(City or town)
(County)
(State)
My post office address is
The place where I took the ship or train which landed me in the United States was
Bremen 2 Germany
, on of October 1913
(Month)
(Day)
(Year)
The ticket on which I camo to this country was bought at
The of the ship railroad do not remember nickar
(City)
(Country)
name or on which I came was
(OVER)
Page data
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- Source index
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- Type
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Document data
- ID
- 159596813
- Core
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- Type
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DTO data
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Context sent to Scholar
Document identity
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4975\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 file my Declaration\nto\nMr.\nAlexandra of Intention (first Gaska paper) to become a citizen Gaska\nMrs. het\naleksandra\nMy name is\nMrs.\n; age,\n5\n45 years.\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 sho on my steamship ticket was\nMy mother\nMy maide namo was (if woman).\nMy present occcupation is\nhouse-wife\n3\nMy personal description is: Color, white\n; complexion, fair\n; height,\n5\nfeet\ninches;\nweight, 145 pounds; color of hair, dark brown ; color of eyes, brown gray\n;\nother visible distinctive marks:\nI was born in\nStanislawowo\nRussia, now\nPoland\n(City or town)\n(Country)\non the\nday of\nApril\n1881\n, ,1\nMy present residence is to\n40 Eastern Ave , New London , Conn.\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post office address is\nThe place where I took the ship or train which landed me in the United States was\nBremen 2 Germany\n, on of October 1913\n(Month)\n(Day)\n(Year)\nThe ticket on which I camo to this country was bought at\nThe of the ship railroad do not remember nickar\n(City)\n(Country)\nname or on which I came was\n(OVER)"
}