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File numbers 4874 - 5509, 1926-1930

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Form 2213 PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN 4889 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. It ulks My name is Mrs. Felix Pankiewicz ; age, 46 Miss (Alien should print or typewrite heré true, original, and correct name) years. (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 My mother maiden name was My maiden namo was (if woman) My present occcupation is Gunsmith My personal description is: Color, White ; complexion, frair ; height, 5 feet 11 inches; weight, 157 of hair, brown pounds; color ; color of blue eyes, ; other visible distinctive marks: Scar on I was born in Chorozycha, (City gr town) I Russia how Paland (Country) My present residence is 58 ms Pleasant St. narwich new London Conn on the 15th day of January , 1880 (Number and street) (City or town) (County) (State) My post office address is 5-8 ms Pleasant It narrich, laun The place where I took the ship or train which landed me in the United States was antwerp Belgium , on (Month) (Day) (Year) The tieket on which I came to this country was bought at The name of the ship or railroad on which I came was (Donitementic) (City) (Country) (OVER) 014-8

Page data

Page
32
Source index
0
Type
photo
Media ID
18286745f757a545
Size
unknown

Document data

ID
159596813
Core
doc
Type
document
DTO data 
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Context sent to Scholar

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Page context 
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    "ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4889\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.\nIt ulks\nMy name is\nMrs.\nFelix Pankiewicz\n; age,\n46\nMiss\n(Alien should print or typewrite heré true, original, and correct name)\nyears.\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 name of the person shown on my steamship ticket was\nMy mother maiden name was\nMy maiden namo was (if woman)\nMy present occcupation is\nGunsmith\nMy personal description is: Color, White ; complexion, frair ; height, 5 feet 11 inches;\nweight, 157 of hair, brown\npounds; color\n; color of blue\neyes,\n;\nother visible distinctive marks: Scar on\nI was born in\nChorozycha,\n(City gr town) I Russia how Paland (Country)\nMy present residence is 58 ms Pleasant St. narwich new London Conn\non the 15th day of January\n, 1880\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post office address is\n5-8 ms Pleasant It narrich, laun\nThe place where I took the ship or train which landed me in the United States was antwerp\nBelgium\n, on\n(Month)\n(Day)\n(Year)\nThe tieket on which I came to this country was bought at\nThe name of the ship or railroad on which I came was\n(Donitementic) (City) (Country)\n(OVER)\n014-8"
}