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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4991
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.
antoni should print or typewrite here true, original, and coprect
38
; age,
years.
Miss
(Alien 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 shown on my steamship ticket
was antoni marginheing
My mother's maiden name was
Jeofila Drilmian
My maiden name was (if woman)
My present occcupation is
laborer
light
61/2
My personal description is: Color, white complexion, light
; height,
5 feet t inches;
weight, 150 pounds; color of hair, light yarh brown ; color of eyes, golary green
other visible distinctive marks: Scaronback of left thumb
I was born in
Krasno Polandinist mm Paland
(City or town)
(Country)
on
the 22nd day of Sept.
, 1 888
My present residence
is 11 Summitt St. norwit when London Yora
(Number and street)
(City or town)
(County)
(State)
My post office address is
some
The place Rotterdar
where I took the ship or train which landed me in the United States was
Holland
Feb.
, on
25, 1910
(Month)
(Day)
(Year)
The ticket on which I came to this country was bought at
Brooklyn,
(City)
n.y.
(Country)
The name of the ship or railroad on which I came was
Ryrdan
(OVER)
c14-8
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Document data
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- Core
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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\n4991\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.\nantoni should print or typewrite here true, original, and coprect\n38\n; age,\nyears.\nMiss\n(Alien 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 shown on my steamship ticket\nwas antoni marginheing\nMy mother's maiden name was\nJeofila Drilmian\nMy maiden name was (if woman)\nMy present occcupation is\nlaborer\nlight\n61/2\nMy personal description is: Color, white complexion, light\n; height,\n5 feet t inches;\nweight, 150 pounds; color of hair, light yarh brown ; color of eyes, golary green\nother visible distinctive marks: Scaronback of left thumb\nI was born in\nKrasno Polandinist mm Paland\n(City or town)\n(Country)\non\nthe 22nd day of Sept.\n, 1 888\nMy present residence\nis 11 Summitt St. norwit when London Yora\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post office address is\nsome\nThe place Rotterdar\nwhere I took the ship or train which landed me in the United States was\nHolland\nFeb.\n, on\n25, 1910\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\nBrooklyn,\n(City)\nn.y.\n(Country)\nThe name of the ship or railroad on which I came was\nRyrdan\n(OVER)\nc14-8"
}