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{
    "localId": "159596813",
    "label": "File numbers 4874 - 5509, 1926-1930",
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    "contentType": "document",
    "title": "File numbers 4874 - 5509, 1926-1930",
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        "Naturalization Records of Non-Federal Courts in Connecticut",
        "Applications for Declaration of Intention"
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{
    "seq": 379,
    "pageIndex": 0,
    "type": "photo",
    "url": "https://s3.amazonaws.com/NARAprodstorage/lz/partnerships-0002/18-0177_US-MA/18-0177_US-MA_21/18-0177_US-MA_-4526886-CTN-Applications-for-Declaration-of--1926-1930/18-0177_US-MA_-4526886-CTN-Applications-for-Declaration-of--1926-1930_00379.jpg",
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    "ocrText": "Olesis of Owurt:\nPlage number\n2496\nin upper corner\nForm 2213\nof all eopies of deolaration immediately under\nFACTS FOR DECLARATION OF INTENTION mation.\n5063\nDoston, Mass,\nof Court:\nin upper left-land cormar\nFROM\nPlace number\nen all' cop of declarari\nyeur baclaration\na\nunder\nU.\nS. DEPARTMENT OF LABOREORGE E. PARSONS\nector\nof\nNATURALIZATION SERVICE\nCLERK OF THE SUPERIOR COURT\n-\nthe\nin\nNORWICH, CONN\na\nNOTES copy Fthis form will be furnished by the clerk of the court, the Chief Naturalization Examiner, or the\ntescher to each applicant for a declaration of intention, so that he can at his leisure fill in the answers to\nthe mestions PAfter being filled out tho applicant should take the form to the office of the clerk of court to bo used\nby hin in, properly filling out the declaration. Care should be used to stato as near as can be remembered the day,\nmonth, an/ryear of arrival, as woll 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 bo paid for assistance in filling it out, as the Naturalization Examiner or the public=school teacher will help you\nfree of charge.\nKempton\nMy name is Kemptor Thomas. O' Bern\nAge: 20 29. years.\n(Añen should state here his true, original, and correct name in full.)\n(Give age at last birthday.)\nAlso known as\n(If alien has used any other name in this country that name should be shown on line immediately above.)\nOccupation: general labore Weaver\nColor: white\nComplezion: medium Fair\nHeight: sife feet light 1/2 Weight: 150/34\ninches. pounds.\nColor of hair: dark brown Color of leyes: brown\nOther visible distinctive marks:\nWhere born: took.) cross anna county (Country.) ins canada\n(If no visible distinctive marks, so state.)\nAlbany\n(City or\nDate of birth: (Month.)\n21st\n1904\n,\n(Day,\n(Year.)\nPresent residence: New Roodder\nConn\n,\n(Number and street.)\n(City or town.)\n(State, Territory, or District.)\nEmigrated from: yarmouth ,\nN s\n(Plaze where alien got on ship or train to come to the United States.)\n(Country.\nName of vessel: prince (If the alien arrived of herwise George than by vessel,\nthe character of conveyance or name of transportation company should be given.)\nLast place of foreign\nresidence: sand (City or town.) cross , annasts (Country.)\nAbany\n*I am not married; the name of my swife Wusbands is\n*born at\n; and now resides at\nI am now a subject of and intend to renounce allegiance to\nGreat Britain\n(Write name and title of sovereign and country of which now a subject; or if citizen of a Republic, write name of Republiconly.)\nI arrived at the port of\nBoston\n, mass,\n(City or town.)\n(State or Territory.)\non OT about December now * 30 1923\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.\nGOVERNMENT PRINTING OFFICE\n14-8"
}