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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 5037 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 Mrg. Sunjaf (Alien should Kostinkevich w ; age, 40 years. Mies Samuel Kostovich correct name) typewrite here true, original, and (Give age last birthday) Also known as (If alien nas used any other name in this country, that name should be shown here) I used that name because smyaler My mother's maiden name was Parasheva Pesochui The full name of the person shown on my steamship ticket was Sergif Kostukeich My maiden name was (if woman) My present occcupation is Amill hand Farmer 33/4 My personal description is: Color, White ; complexion, fair ; height, 5 feet X inches; weight, 156 pounds; color of hair, brown ; color of eyes, blue ; other visible distinctive marks: none I was born in misk Rudsia on the / day of or torn) Octoba (Country) 886 My present residence is Lebanon n.L. Come My post office address is (City town) Correct (County) (Number and street) or The place where I took the ship or train which landed me in the United States was Liban, Russia youte R20.71 (State) The ticket which I came to this Lifan , on June (Month) 4 Russia (Das) 1911 (Year) on country was bought at The Lituania (City) (Country) name of the ship or railroad on which I came was (OVER) e14-8

Page data

Page
327
Source index
0
Type
photo
Media ID
21d74d2e31bcf5c7
Size
unknown

Document data

ID
159596813
Core
doc
Type
document
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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\n5037\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\nMrg.\nSunjaf (Alien should Kostinkevich w\n; age,\n40\nyears.\nMies\nSamuel Kostovich correct name)\ntypewrite here true, original, and\n(Give age last birthday)\nAlso known as\n(If alien nas used any other name in this country, that name should be shown here)\nI used that name because\nsmyaler\nMy mother's maiden name was Parasheva Pesochui\nThe full name of the person shown on my steamship ticket was Sergif Kostukeich\nMy maiden name was (if woman)\nMy present occcupation is Amill hand Farmer\n33/4\nMy personal description is: Color, White ; complexion, fair\n; height, 5 feet X inches;\nweight, 156 pounds; color of hair, brown\n;\ncolor of eyes, blue\n;\nother visible distinctive marks: none\nI was born in misk\nRudsia\non the\n/\nday of or torn)\nOctoba\n(Country)\n886\nMy present residence is\nLebanon n.L. Come\nMy post office address is (City town) Correct (County)\n(Number and street)\nor\nThe place where I took the ship or train which landed me in the United States was Liban, Russia\nyoute\nR20.71\n(State)\nThe ticket which I came to this Lifan\n, on June (Month) 4 Russia (Das) 1911 (Year)\non country was bought at\nThe Lituania (City)\n(Country)\nname of the ship or railroad on which I came was\n(OVER)\ne14-8"
}