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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5021
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 (first to become citizen.
Mr. file my Declaration of Intention Bonkowski paper)
My name is
Mrs.
Bronistan Benhanth
; age,
36
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 name of the person shown on my steamship ticket was
same
My mother's maiden name was
anna Junez
My maiden name was (if woman)
My present occcupation is
laborer
742
My personal description is: Color, white ; complexion, light
; height, 5 feet * inches;
weight, 155 pounds; color of hair, dunt hour ; color gray eyes, goes
of
other visible distinctive marks: Scaro polart left fortinger
I was born in
on the 3rd
Jadnacer
Rudsia,now
Poland
(City or town)
(Country)
day of
Dec.
, 1 8819
My present residence is
70 Spring St. nornick (County) new London (State)
Corr.
(Number and street)
(City or town)
My post office address is
same
The place where L took the ship or train which landed me in the United States was
Hamby
Germany
on
her
15
1912
(Month)
(Day)
(Year)
The ticket on which I came to this country was bought at
Hamling
(City)
Sermany
(Country)
The name of the ship or railroad on which I came was
Hambing
(OVER)
614-8
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Document data
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- Core
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- Type
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DTO data
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5021\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\nstatements\nin the regular order as they are to appear on the Declaration of Intention.)\nI desire to (first to become citizen.\nMr. file my Declaration of Intention Bonkowski paper)\nMy name is\nMrs.\nBronistan Benhanth\n; age,\n36\nyears.\nMiss\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 full name of the person shown on my steamship ticket was\nsame\nMy mother's maiden name was\nanna Junez\nMy maiden name was (if woman)\nMy present occcupation is\nlaborer\n742\nMy personal description is: Color, white ; complexion, light\n; height, 5 feet * inches;\nweight, 155 pounds; color of hair, dunt hour ; color gray eyes, goes\nof\nother visible distinctive marks: Scaro polart left fortinger\nI was born in\non the 3rd\nJadnacer\nRudsia,now\nPoland\n(City or town)\n(Country)\nday of\nDec.\n, 1 8819\nMy present residence is\n70 Spring St. nornick (County) new London (State)\nCorr.\n(Number and street)\n(City or town)\nMy post office address is\nsame\nThe place where L took the ship or train which landed me in the United States was\nHamby\nGermany\non\nher\n15\n1912\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\nHamling\n(City)\nSermany\n(Country)\nThe name of the ship or railroad on which I came was\nHambing\n(OVER)\n614-8"
}