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Form 2213 4993
BERVICE
FACTS FOR DECLARATION OF INTENTION
RECEIVED
Clerk of
Plane number
18644
in upper left-hand cerner
FEB 2 1926
of all of declaration unde U. S. DEPARTMENT OF LABOR
your declaration number.
Dietrict Directer of Naturaliza NATURALIZATION SERVICE
Boston, Mass,
OFFICE HAVEN,
NEW of LASOR
NOTE.-A copy of this form will be furnished by the clork of the court, the Chief Naturalization Examiner, or
the
public-school toacher to each applicant for a doclaration of intention, so that ho can at his leisuro fill in the answers to
the questions. After being filled out the applicant should take the form to the office of the clerk of court to be used
by him in properly filling out the declaration. Care should bo used to state as near as can be remembered the day,
month, and year of arrival, as well as the name of the vessol on which the alien emigrated to this country.
TO THE APPLICANT.-The fee of one dollar required by law for the declaration, must be paid to the clerk of the
court beforo he commences to fill out the declaration of intention. No fee is chargeable for this blank, and none
should be paid for assistance in filling it out, as the Naturalization Examiner or the public-school teacher will help you
fres of charge.
Milsson
My name is Eric Waldemas herson
Age: 120 years.
(Alien should state here his true, original, and correct name in full.)
(Give age at last birthday.)
Also known as
(Ifalien 12 used any other name in this country, that name should be shown on line immediately above.)
Occupation:
Color: White
Carpentes
Complezion: Fair
Height:
of
feet
&9 t inches. Weight: 142 160 pounds.
Color of hair: Arrown tight
Color of eyes: Blue
Other visible distinctive marles:
none Scarsonlelt thumb
(If no visible distinctive marks, so state)
Where born: Jonnessjo
Twiched
,
(City or town.)
(Country.)
Date of birth:
July
first
6906
,
(Month)
(Day.)
(Year.)
Present residence:
z morse aves
Eraton
Comm
,
(Number and street.)
(City or town.)
Emigrated from:
Tweeker
(State, Territory, or District.)
Forpinture
(Place "where alien got on ship or trains to come to the United States.)
(Country.)
Name of vessel:
(If
the
alien arrived otherwise of conveyance or name of transportation company should be given.)
Last place of foreign residence:
Halmstad
Twedere
(City or town.)
(Country.)
*I am not married; the name of my
swife (husbands is
the shel was
4
*born at
;
at
I am now a subject of and intend talkapounce allegiance to Eustaurs
members
Sing (Write of title of soyereign I weder and of which subject; 1926
name and country now a or if citizen of a Republic, write name of Republiconly.)
I arrived at the port of
new Roat (City or town.)
,
(State or Territory.)
on or about
January
20th
,
(Month.)
(Day.)
1 g
1929
(Year.)
* NOTE TO CLERK OF COURT.-The two lines indicated by the * contain information which is provided for by blanks on the latest
declaration of intention form; until such time as you may be supplied with forms containing these blank spaces the information called
for herein should be inserted immediately ABOVE the twelfth line, which begins It is my bona fide intention,' etc., as requested in
circular letter of January 5, 1916.
GOVERNMENT PRINTING OFFICE
14-
IA issued
APR 23 1926
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"ocrText": "Form 2213 4993\nBERVICE\nFACTS FOR DECLARATION OF INTENTION\nRECEIVED\nClerk of\nPlane number\n18644\nin upper left-hand cerner\nFEB 2 1926\nof all of declaration unde U. S. DEPARTMENT OF LABOR\nyour declaration number.\nDietrict Directer of Naturaliza NATURALIZATION SERVICE\nBoston, Mass,\nOFFICE HAVEN,\nNEW of LASOR\nNOTE.-A copy of this form will be furnished by the clork of the court, the Chief Naturalization Examiner, or\nthe\npublic-school toacher to each applicant for a doclaration of intention, so that ho can at his leisuro fill in the answers to\nthe questions. After being filled out the applicant should take the form to the office of the clerk of court to be used\nby him in properly filling out the declaration. Care should bo used to state as near as can be remembered the day,\nmonth, and year of arrival, as well as the name of the vessol on which the alien emigrated to this country.\nTO THE APPLICANT.-The fee of one dollar required by law for the declaration, must be paid to the clerk of the\ncourt beforo he commences to fill out the declaration of intention. No fee is chargeable for this blank, and none\nshould be paid for assistance in filling it out, as the Naturalization Examiner or the public-school teacher will help you\nfres of charge.\nMilsson\nMy name is Eric Waldemas herson\nAge: 120 years.\n(Alien should state here his true, original, and correct name in full.)\n(Give age at last birthday.)\nAlso known as\n(Ifalien 12 used any other name in this country, that name should be shown on line immediately above.)\nOccupation:\nColor: White\nCarpentes\nComplezion: Fair\nHeight:\nof\nfeet\n&9 t inches. Weight: 142 160 pounds.\nColor of hair: Arrown tight\nColor of eyes: Blue\nOther visible distinctive marles:\nnone Scarsonlelt thumb\n(If no visible distinctive marks, so state)\nWhere born: Jonnessjo\nTwiched\n,\n(City or town.)\n(Country.)\nDate of birth:\nJuly\nfirst\n6906\n,\n(Month)\n(Day.)\n(Year.)\nPresent residence:\nz morse aves\nEraton\nComm\n,\n(Number and street.)\n(City or town.)\nEmigrated from:\nTweeker\n(State, Territory, or District.)\nForpinture\n(Place \"where alien got on ship or trains to come to the United States.)\n(Country.)\nName of vessel:\n(If\nthe\nalien arrived otherwise of conveyance or name of transportation company should be given.)\nLast place of foreign residence:\nHalmstad\nTwedere\n(City or town.)\n(Country.)\n*I am not married; the name of my\nswife (husbands is\nthe shel was\n4\n*born at\n;\nat\nI am now a subject of and intend talkapounce allegiance to Eustaurs\nmembers\nSing (Write of title of soyereign I weder and of which subject; 1926\nname and country now a or if citizen of a Republic, write name of Republiconly.)\nI arrived at the port of\nnew Roat (City or town.)\n,\n(State or Territory.)\non or about\nJanuary\n20th\n,\n(Month.)\n(Day.)\n1 g\n1929\n(Year.)\n* NOTE TO CLERK OF COURT.-The two lines indicated by the * contain information which is provided for by blanks on the latest\ndeclaration of intention form; until such time as you may be supplied with forms containing these blank spaces the information called\nfor herein should be inserted immediately ABOVE the twelfth line, which begins It is my bona fide intention,' etc., as requested in\ncircular letter of January 5, 1916.\nGOVERNMENT PRINTING OFFICE\n14-\nIA issued\nAPR 23 1926"
}