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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5075
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
RATURALIZATION SERVICE:
31411
Place number
In
RECELVED
CARD INDEX
upper left-hand corner of all copies of
declaration, immediately under your
INDEX BOOKS
FEB 1 ISET
declaration number.
OFFICE OF EXAMINER
DISTRICT DIRECTOR OF NATURALIZATION.
MANIFESTS
NEW HAVEN, CONN.
DEPARTMENT OF MABOR
(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
Mrs.
HORATIO GREGORY
OF
;
age,
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give last
Also known as
2.
received
age birthday) ICN
(If alien has used any other in this country, should be shown here) 01997
name that name
I used that name because
ACKND
in
The full name of on ticket was
the person shown my steamship HORATIO GREGORY
My mother's maiden name was
HANNAH LAZENBY.
My maiden name was (if woman)
My present occcupation is
Cook.
My personal description is: Color, While ; complexion, Dark
; height, inches;
5 feet 11g. 81/4
weight, 165 pounds; color of hair,
Black
; color of eyes,
;
other visible distinctive
marks:
I was born in
Sheffield
(City or town)
Eng land (Country)
on the
day
of
Novem ber
, 1897 Preston,
My present residence is Bosc 476 State Hospital, Norwich, New London Coun:
(Number and street)
(City or town)
(County)
(State)
My post office address is
Box 476 Norwich Connecticutt
the place where I took the or train which landed Liverhool
ship me in the United States was
England
on June (Month)
5th
,
1925
(Day)
(Year)
The ticket on which I came to this country was bought at
sheffield
on
Eng (Country) land
The name of the ship or railroad on which I came was
S.S. Scythia
(OVER)
014-8
O/A ISSUED
MAR 19 1927
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5075\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\nRATURALIZATION SERVICE:\n31411\nPlace number\nIn\nRECELVED\nCARD INDEX\nupper left-hand corner of all copies of\ndeclaration, immediately under your\nINDEX BOOKS\nFEB 1 ISET\ndeclaration number.\nOFFICE OF EXAMINER\nDISTRICT DIRECTOR OF NATURALIZATION.\nMANIFESTS\nNEW HAVEN, CONN.\nDEPARTMENT OF MABOR\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\nMrs.\nHORATIO GREGORY\nOF\n;\nage,\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give last\nAlso known as\n2.\nreceived\nage birthday) ICN\n(If alien has used any other in this country, should be shown here) 01997\nname that name\nI used that name because\nACKND\nin\nThe full name of on ticket was\nthe person shown my steamship HORATIO GREGORY\nMy mother's maiden name was\nHANNAH LAZENBY.\nMy maiden name was (if woman)\nMy present occcupation is\nCook.\nMy personal description is: Color, While ; complexion, Dark\n; height, inches;\n5 feet 11g. 81/4\nweight, 165 pounds; color of hair,\nBlack\n; color of eyes,\n;\nother visible distinctive\nmarks:\nI was born in\nSheffield\n(City or town)\nEng land (Country)\non the\nday\nof\nNovem ber\n, 1897 Preston,\nMy present residence is Bosc 476 State Hospital, Norwich, New London Coun:\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post office address is\nBox 476 Norwich Connecticutt\nthe place where I took the or train which landed Liverhool\nship me in the United States was\nEngland\non June (Month)\n5th\n,\n1925\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\nsheffield\non\nEng (Country) land\nThe name of the ship or railroad on which I came was\nS.S. Scythia\n(OVER)\n014-8\nO/A ISSUED\nMAR 19 1927"
}