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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5061
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
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
John, William, Le Coca.
; age,
58
years.
Mise
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
My present occupation is
Officer,
"
The salvation Army"
My personal description is: Color,
white Dark:
414
; complexion,
Dark
; height, 5ft feet 5 inches;
weight,
172 pounds; color of hair, Dark & Grey
; color of eyes, Brown
;
other
visible distinctive marks: Indianik
I was born in
St Heliers,
Jersey,
Channel Islands Great Britain
(City or town)
(Country)
on the
13th day of
April
869
My present residence is
27
Saate St,
New London,
Conn.
(Number and street)
(City or town)
(County)
(State)
The place where I took the ship or train which landed me in the United States was
Toronto
Onts
Canada.
October
12th,
1908
,on
(Month)
(Day)
(Year)
The name of the ship or railroad on which I came was
Canadian Pacific >R Co Railroad
My last place of foreign residence was
sandy
Toronto, Ont,
Canada,
(City or town)
is llen
(Country)
I am Yes. married. The name of my
wife
Emily E. Le Cocq
She
zhusbaod
was born at
said27
Gaspie. que, Canada
and now resides at New London,
Conn,
I am now a subject of and intend to renounce allegiance to
Great Britan
(Write name and title of sovereign and country of which now a subject;
King George 5
or, if citizen of a republic, write name of republic only)
I arrived at the United States immigration port of
Niagara Falls, N.Y.
(City or town)
on October 12th, 1908
,
(State or territory)
14-8
(Give exact month, day, and year)
2 (OVER)
Page data
- Page
- 375
- Source index
- 0
- Type
- photo
- Media ID
- 72f33130f70ecfec
- Size
- unknown
Document data
- ID
- 159596813
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
Document identity
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Document source metadata
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Document source extras
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Page context
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5061\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\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nJohn, William, Le Coca.\n; age,\n58\nyears.\nMise\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nMy present occupation is\nOfficer,\n\"\nThe salvation Army\"\nMy personal description is: Color,\nwhite Dark:\n414\n; complexion,\nDark\n; height, 5ft feet 5 inches;\nweight,\n172 pounds; color of hair, Dark & Grey\n; color of eyes, Brown\n;\nother\nvisible distinctive marks: Indianik\nI was born in\nSt Heliers,\nJersey,\nChannel Islands Great Britain\n(City or town)\n(Country)\non the\n13th day of\nApril\n869\nMy present residence is\n27\nSaate St,\nNew London,\nConn.\n(Number and street)\n(City or town)\n(County)\n(State)\nThe place where I took the ship or train which landed me in the United States was\nToronto\nOnts\nCanada.\nOctober\n12th,\n1908\n,on\n(Month)\n(Day)\n(Year)\nThe name of the ship or railroad on which I came was\nCanadian Pacific >R Co Railroad\nMy last place of foreign residence was\nsandy\nToronto, Ont,\nCanada,\n(City or town)\nis llen\n(Country)\nI am Yes. married. The name of my\nwife\nEmily E. Le Cocq\nShe\nzhusbaod\nwas born at\nsaid27\nGaspie. que, Canada\nand now resides at New London,\nConn,\nI am now a subject of and intend to renounce allegiance to\nGreat Britan\n(Write name and title of sovereign and country of which now a subject;\nKing George 5\nor, if citizen of a republic, write name of republic only)\nI arrived at the United States immigration port of\nNiagara Falls, N.Y.\n(City or town)\non October 12th, 1908\n,\n(State or territory)\n14-8\n(Give exact month, day, and year)\n2 (OVER)"
}