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Form 2213
SERVICE
4898
FACTS FOR DECLARATION OF INTENTION
RECEIVED
of Oourt
18905
Plazo
in appar left-hand oorner
at all coptes af deelaration Immediately under
U. S. DEPARTMENT OF LABOR
FEB 12 1550
your declaration numbar.
Diatrict Director of Naturali NATURALIZATION SERVICE
Boston, Mase,
OF EXAMINER
EPARTMENT
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 leisuro fill in the answers to
the questions. After being filled out the applicant should tako the form to the office 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 feo of one dollar required by law for the declaration, must be paid to the clerk of the
court before ho commences to fill out the declaration of Intention. No feo 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
froo of charge.
nathalia
X
25
My name
is (Alien should state Nathalin here his true, original, and Nelson correct in full.)
Age:
years.
name
(Give age at lost birthday.)
Also known as
Occupation: housemard (Ifalien any
has used other name in this country, that name should be shown on line immediately above.)
Color: While
Complexion: Fair
Height: 5
feet
5 1/2
inches. Weight: 135 pounds.
Color of hair: Browns light brown Color
of eyes: blue
Other visible distinctive marks:
none
visible distinctivo marks, so state.)
Where born:
(City or town.)
(Country.)
Date of birth:
Both.sepe
1201
(Month.) (Day.)
ironander
(Year.)
Present
Conn
,
,
Frank
(Number and street.)
(City or town.)
(State, Territory, or District.)
Emigrated from: Gathenburg.
Sweden
(Place where alien got onship or train to come to the United States, )
(Country.)
and
Name
of vessel: byyessel, of centrany should be
arrived otherwisethan the character of canveyanceor name transportation given.)
Last place of foreign residence:
CCty or town.)
(Country.)
*I am not married; the name of my
take]was
*born at because
; and now resides at Air
I am now a subject of and intend to remounce allegiance to
High (Write title sovereign country Gustaons subject; if citizen of Republic, Ring write Republic sweden only.)
name and of and of which now a or a dame of
I arrived at the port as (City
york.
,
or town.)
(State or Territory.)
on O7° about (Month)
9
2519 , 1905
(Day.)
(Year.)
1926
*
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.
BIA
14-8
APR 24 1928
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"ocrText": "Form 2213\nSERVICE\n4898\nFACTS FOR DECLARATION OF INTENTION\nRECEIVED\nof Oourt\n18905\nPlazo\nin appar left-hand oorner\nat all coptes af deelaration Immediately under\nU. S. DEPARTMENT OF LABOR\nFEB 12 1550\nyour declaration numbar.\nDiatrict Director of Naturali NATURALIZATION SERVICE\nBoston, Mase,\nOF EXAMINER\nEPARTMENT\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 leisuro fill in the answers to\nthe questions. After being filled out the applicant should tako the form to the office 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 feo of one dollar required by law for the declaration, must be paid to the clerk of the\ncourt before ho commences to fill out the declaration of Intention. No feo 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\nfroo of charge.\nnathalia\nX\n25\nMy name\nis (Alien should state Nathalin here his true, original, and Nelson correct in full.)\nAge:\nyears.\nname\n(Give age at lost birthday.)\nAlso known as\nOccupation: housemard (Ifalien any\nhas used other name in this country, that name should be shown on line immediately above.)\nColor: While\nComplexion: Fair\nHeight: 5\nfeet\n5 1/2\ninches. Weight: 135 pounds.\nColor of hair: Browns light brown Color\nof eyes: blue\nOther visible distinctive marks:\nnone\nvisible distinctivo marks, so state.)\nWhere born:\n(City or town.)\n(Country.)\nDate of birth:\nBoth.sepe\n1201\n(Month.) (Day.)\nironander\n(Year.)\nPresent\nConn\n,\n,\nFrank\n(Number and street.)\n(City or town.)\n(State, Territory, or District.)\nEmigrated from: Gathenburg.\nSweden\n(Place where alien got onship or train to come to the United States, )\n(Country.)\nand\nName\nof vessel: byyessel, of centrany should be\narrived otherwisethan the character of canveyanceor name transportation given.)\nLast place of foreign residence:\nCCty or town.)\n(Country.)\n*I am not married; the name of my\ntake]was\n*born at because\n; and now resides at Air\nI am now a subject of and intend to remounce allegiance to\nHigh (Write title sovereign country Gustaons subject; if citizen of Republic, Ring write Republic sweden only.)\nname and of and of which now a or a dame of\nI arrived at the port as (City\nyork.\n,\nor town.)\n(State or Territory.)\non O7° about (Month)\n9\n2519 , 1905\n(Day.)\n(Year.)\n1926\n*\nNOTE\nTO 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.\nBIA\n14-8\nAPR 24 1928"
}