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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4988
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 wells (first paper) to become a citizen.
Mr.
My name is
Mrs.
Charles N. Paliocha
; age,
21
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 namo of the person shown on my steamship ticket was
My mother s maidon name was
My maiden namo was (if -woman)
My present occcupation
is Poultry management
to
My personal description is: Color, white ; complexion, dark
; height, 5
feet 9% inches;
weight, 180 pounds; color of hair, dark brown color of eyes, brown
;
other visible distinctive marks: Scaronlift furfinger
I was born in
Catrog
&
Russia
(City or town)
8th march
(Country)
on the
day of
1906
My present residence is A7 W. Jharnes sh, norwich, new London tea., bonn.
ist
(Number and street)
(City or town)
(County)
(State)
My post office address is
as above Charles n. Pahocha, R.F.D.1
The place where I took the ship or train which landed me in the United States was R atterdam
no. 7
Holland
on norser Dec
1910
,
(Month)
(Day)
(Year)
The ticket on which I came to this country was bought at
(City)
(Country)
The name of the ship or railroad on which I came was (OVER) manifacturne
c14-8
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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\n4988\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 wells (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nCharles N. Paliocha\n; age,\n21\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nAlso known as\n(If\nalien has used any other name in this country, that name should be shown here)\nI used that name because\nThe full namo of the person shown on my steamship ticket was\nMy mother s maidon name was\nMy maiden namo was (if -woman)\nMy present occcupation\nis Poultry management\nto\nMy personal description is: Color, white ; complexion, dark\n; height, 5\nfeet 9% inches;\nweight, 180 pounds; color of hair, dark brown color of eyes, brown\n;\nother visible distinctive marks: Scaronlift furfinger\nI was born in\nCatrog\n&\nRussia\n(City or town)\n8th march\n(Country)\non the\nday of\n1906\nMy present residence is A7 W. Jharnes sh, norwich, new London tea., bonn.\nist\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post office address is\nas above Charles n. Pahocha, R.F.D.1\nThe place where I took the ship or train which landed me in the United States was R atterdam\nno. 7\nHolland\non norser Dec\n1910\n,\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\n(City)\n(Country)\nThe name of the ship or railroad on which I came was (OVER) manifacturne\nc14-8"
}