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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4990.
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.
Miss
/
Stanislaw Sienkiewicz
33-
; age,
years.
(Alien should print or typewrite here true, original, and correct name)
Also known as
Stanislaw Chwal
(Give age last birthday)
(If alien has used any other name in this country, that name should be shown here)
I used that name because Easier to pronounce
The full of the shown Stanislaw ch wal
name person on my steamship ticket was
My was Aniela facimiersha.
mother's maiden name
My maiden name was (if woman)
My present occcupation is carpenter
My is:
personal description Color, While complexion, fair light ; height, 5 feet 9 8
weight, 163 pounds; color of hair, blondight ; color of eyes, grey blue
inches;
other visible distinctive marks: nons
I was
born in Brzostek town) , galicia now 31 Polond.
on the
18
day
of Road
April
893
(Country) himsh
My present residence is 88 Oxtabando norwichtown, Conth
(Number and street)
(City or town)
(County)
n
(State)
My post office address is same Boy57
The place where I took the ship or train which landed me in the United States was Bremen,
fermany
,
on
ticket on which I came to this country was bought at Bremen, Germany (Country)
14 (Month) of August 1913 (Year)
The
The name of the ship or railroad on which I came was
Rhein, (City)
(OVER)
014-8
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4990.\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.\nMiss\n/\nStanislaw Sienkiewicz\n33-\n; age,\nyears.\n(Alien should print or typewrite here true, original, and correct name)\nAlso known as\nStanislaw Chwal\n(Give age last birthday)\n(If alien has used any other name in this country, that name should be shown here)\nI used that name because Easier to pronounce\nThe full of the shown Stanislaw ch wal\nname person on my steamship ticket was\nMy was Aniela facimiersha.\nmother's maiden name\nMy maiden name was (if woman)\nMy present occcupation is carpenter\nMy is:\npersonal description Color, While complexion, fair light ; height, 5 feet 9 8\nweight, 163 pounds; color of hair, blondight ; color of eyes, grey blue\ninches;\nother visible distinctive marks: nons\nI was\nborn in Brzostek town) , galicia now 31 Polond.\non the\n18\nday\nof Road\nApril\n893\n(Country) himsh\nMy present residence is 88 Oxtabando norwichtown, Conth\n(Number and street)\n(City or town)\n(County)\nn\n(State)\nMy post office address is same Boy57\nThe place where I took the ship or train which landed me in the United States was Bremen,\nfermany\n,\non\nticket on which I came to this country was bought at Bremen, Germany (Country)\n14 (Month) of August 1913 (Year)\nThe\nThe name of the ship or railroad on which I came was\nRhein, (City)\n(OVER)\n014-8"
}