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OCR
1--5-7731
Form 2213 5054
VATIONAL
FACTS FOR DECLARATION OF INTENTION SERVICE
Clerk of Court: number 32209 in upper left-hand
al all Placa coples of declaretien immediately under
your declaration number Director et Matur U.S. DEPARTMENT LABOR
OF
APR 23 1927
Bestom,
NATURALIZATION SERVICE
OFFICE OF EXAMINER
NEW HAVEN, CONN.
ON bABOR-
NOTE.-A copy of this form will be furnished by the clerk of the court, the Chief Naturalization Examiner, or the
public-school teacher to each applicant for a declaration of intention, so that he can at his leisure fill in the answers to
the questions. After being filled out the applicant should take the form to the offico of the clerk of court to be used
by him in properly filling out the declaration. Care should be used to state as near as can be remembered the day,
month, and year of arrival, as well as the name of the vessel 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 before 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
free of charge.
Jose
My name is
Jusept (Alien should Sommer state here his true, josef original, and
Age:
49
years.
Correct name in full.)
(Give age at last birthday.)
Also known as
-
(Ifalien has used any other name in this country, that name should be shown on line immediately above.)
Occupation: Farmer
Color:
Whi te
Complexion:
Fair
Height:
5
feet
4
inches. Weight:
140
pounds.
Color of hair:
Brown
Color of eyes:
Blue
Other visible distinctive marks:
None
(If no visible distinctivo marks, so state.)
Where born:
Girm
Austria - - Birgonland
,
(City or town.)
(Country.)
Date of birth:
November
23
1877
,
(Month.)
Present residence:
10 Washingt on, St.
Mystic (Day.) Storinglond Conn. (Year.)
(Number and street.)
(City or town.)
(State, Territory, or District.)
Emigrated from:
\ Area to
,
(Place where alien got on ship or train to come to the mited States.)
Hamburg (Country.) - Sermany
Name of vessel:
Westphal ia
(If the alien arrived otherwise than by vesse) athe character of conveyance or name of transportation company should be given.)
Last place of foreign residence:
Deutsch Kreitz
Austria
,
(City or town.)
(Country.)
*I am
married; the
name 'my
is
Maria Sommer
(she) was
*born
said Boish Kroi
at DEUTSCH KREUA
,
and now resides at said Doish Kreutz
the
DEUTSCH
I am now a subject of and intendato renounce allegiance to Republic of Austria
the
(Write name and title of sovereign and country of which now a subject; or if citizen of a Republic, write name of Republic only.)
I arrived at the port of
New York City
New York
(City or town.)
(State or Territory.)
on OF° about
September
1923.
,
(Month.)
(Day)
(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.
GOVDRNMENT PRINTING OFFICE
14-8
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"ocrText": "1--5-7731\nForm 2213 5054\nVATIONAL\nFACTS FOR DECLARATION OF INTENTION SERVICE\nClerk of Court: number 32209 in upper left-hand\nal all Placa coples of declaretien immediately under\nyour declaration number Director et Matur U.S. DEPARTMENT LABOR\nOF\nAPR 23 1927\nBestom,\nNATURALIZATION SERVICE\nOFFICE OF EXAMINER\nNEW HAVEN, CONN.\nON bABOR-\nNOTE.-A copy of this form will be furnished by the clerk of the court, the Chief Naturalization Examiner, or the\npublic-school teacher to each applicant for a declaration of intention, so that he can at his leisure fill in the answers to\nthe questions. After being filled out the applicant should take the form to the offico of the clerk of court to be used\nby him in properly filling out the declaration. Care should be used to state as near as can be remembered the day,\nmonth, and year of arrival, as well as the name of the vessel 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 before 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\nfree of charge.\nJose\nMy name is\nJusept (Alien should Sommer state here his true, josef original, and\nAge:\n49\nyears.\nCorrect name in full.)\n(Give age at last birthday.)\nAlso known as\n-\n(Ifalien has used any other name in this country, that name should be shown on line immediately above.)\nOccupation: Farmer\nColor:\nWhi te\nComplexion:\nFair\nHeight:\n5\nfeet\n4\ninches. Weight:\n140\npounds.\nColor of hair:\nBrown\nColor of eyes:\nBlue\nOther visible distinctive marks:\nNone\n(If no visible distinctivo marks, so state.)\nWhere born:\nGirm\nAustria - - Birgonland\n,\n(City or town.)\n(Country.)\nDate of birth:\nNovember\n23\n1877\n,\n(Month.)\nPresent residence:\n10 Washingt on, St.\nMystic (Day.) Storinglond Conn. (Year.)\n(Number and street.)\n(City or town.)\n(State, Territory, or District.)\nEmigrated from:\n\\ Area to\n,\n(Place where alien got on ship or train to come to the mited States.)\nHamburg (Country.) - Sermany\nName of vessel:\nWestphal ia\n(If the alien arrived otherwise than by vesse) athe character of conveyance or name of transportation company should be given.)\nLast place of foreign residence:\nDeutsch Kreitz\nAustria\n,\n(City or town.)\n(Country.)\n*I am\nmarried; the\nname 'my\nis\nMaria Sommer\n(she) was\n*born\nsaid Boish Kroi\nat DEUTSCH KREUA\n,\nand now resides at said Doish Kreutz\nthe\nDEUTSCH\nI am now a subject of and intendato renounce allegiance to Republic of Austria\nthe\n(Write name and title of sovereign and country of which now a subject; or if citizen of a Republic, write name of Republic only.)\nI arrived at the port of\nNew York City\nNew York\n(City or town.)\n(State or Territory.)\non OF° about\nSeptember\n1923.\n,\n(Month.)\n(Day)\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.\nGOVDRNMENT PRINTING OFFICE\n14-8"
}