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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4982
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 my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
Automic Goucalous,
; age,
41
years.
Mies
(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 person shown on my steamship ticket was
full name of the Antonio Goucaloes.
My mother's maiden name was yustria Jusac.
My maiden name was (if woman)
My
My personal description is: Color, white fair dark
present occcupation is Helpre in machine shop
; complexion,
; height,
5 feet 6. inches;
weight, ISS pounds; color of hair, black darkbrown color of blue brown
; eyes,
check I was born in 7mehal Camora A Madrira Islands
other visible distinctive marks: birth dedocas, mark on right check. moterouright
Portugal
(City or town)
(Countly)
on the
11
day of February
1885
My present residence is 41 Maple St. Stoningtone Kidfordon, Come
(Number and street)
(City or town)
(County)
(State)
My post office address is "
"
"
11
11
The place where I took the ship train which landed in the United States was SH Michaels
or me
Azon rlaude
, on
July
(Month)
(Day)
(Year)
The ticket on which I came to this country was bought at
is Michach Bou slandi
The Canada
(City)
(Country)
name of the ship or railroad on which I came was
(OVER)
014-8
Page data
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Document data
- ID
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- Core
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- Type
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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\n4982\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 my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nAutomic Goucalous,\n; age,\n41\nyears.\nMies\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 person shown on my steamship ticket was\nfull name of the Antonio Goucaloes.\nMy mother's maiden name was yustria Jusac.\nMy maiden name was (if woman)\nMy\nMy personal description is: Color, white fair dark\npresent occcupation is Helpre in machine shop\n; complexion,\n; height,\n5 feet 6. inches;\nweight, ISS pounds; color of hair, black darkbrown color of blue brown\n; eyes,\ncheck I was born in 7mehal Camora A Madrira Islands\nother visible distinctive marks: birth dedocas, mark on right check. moterouright\nPortugal\n(City or town)\n(Countly)\non the\n11\nday of February\n1885\nMy present residence is 41 Maple St. Stoningtone Kidfordon, Come\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post office address is \"\n\"\n\"\n11\n11\nThe place where I took the ship train which landed in the United States was SH Michaels\nor me\nAzon rlaude\n, on\nJuly\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\nis Michach Bou slandi\nThe Canada\n(City)\n(Country)\nname of the ship or railroad on which I came was\n(OVER)\n014-8"
}