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{
    "localId": "159596813",
    "label": "File numbers 4874 - 5509, 1926-1930",
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    "title": "File numbers 4874 - 5509, 1926-1930",
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        "Naturalization Records of Non-Federal Courts in Connecticut",
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    "ocrText": "4899\n23217\n7734\nForm 2213\nClerk of Courti\nPlasa number\nFACTS FOR DECLARATION OF INTENTION\nupper\nTero-nand\ncernor\nat all copfes of dectaration Imma Hately under\nyour declaration number.\nFROM\nDietriot Bircet\nBoston, U. .S. DEPARTMENT OF QRGE E PARSONS\nATURALIZATION SERVICE\nOK THE SUPERIOR COURT\nC 1925\nORWICH. CONN\nNOTE.-A copy of this form will be furnished the clerk of toprourt, the Chief Nathralization Examiner, or the\npublic-school teacher to each applicant for a declaration of imfention, sottat he can at his leisuro fill in the answers to\nthe questions. After being filled out the applicant should the office of the clerk of court to bo used\nby him in properly filling out the declaration. Caro should bounsed to state As pear as can be remembered the\nday,\nmonth, and year of arrival, as well as the name of the vessel on which the alien émigrated 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 ntention. No-feo is chargeable for this blank, and none\nshould be paid for assistance in filling it out, as the Naturalization Examiner Ox theppiblic-school teacher will help you\nfree of charge.\nMyname is John (Alien should Thomas state here his true, original, Robinson in full.)\n32\nAge: 31\nyears.\nand correct name\n(Give age at last birthday.)\nAlso kcnown as\nn\n2\nbotton Weaver\n(Ifalien has used any other name in this country, that name should be shown on line immediately above.)\nOccupation:\nColor: While\nComplexion:\nDark\nHeight: 5\nfeet\n6\n$\ninches. Weight: 136\npounds.\nColor\nof hair: Dark Brown\nColor of eyes: Grey\nOther visible distinctive marks:\nBlackburn\nMark on (If left visibl distinctive marks eye state.) Scar\nno so\nWhere born:\n,\n(City or town.)\nEnfland\nDate of birth:\nMay\n6th\n(Country.)\n,\n,\n(Month.)\n(Day.)\n1894\n(Year.)\nMyslic Our, Lower Pacreatuch Stonington Buh\nGpn\nPresent residence:\nNumber and street.)\ndiverpool\n(City or town.)\n(State, Territory gr District.)\nEmigrated from:\n(Place where alien got ship or train to come to the United States.)\nof vessel: S.S. beltic White Starting\nEngland (Country.)\nName\n(If the alien arrived Othesziso the character of conveyanco or name of transportation company should be given.)\nLast place of foreign residence said Blackbum ,\n(City or town.)\nEngland\n(Country.)\n*I am the name\nborn said at Blackburn\nmarried; of my Swife tousband, is Elizabeth Hannah (she) the was\n*\n;\nand now resides shid at Myslic luve Lowe Pawcatian\nI subject of and intend allegiance to H.M. King\nam now a to renounce\nGeorge (Writename and title V of sovereign of and country England of hich subject; if\nnow a or citizen of a Republic, write name of Republic only.)\nI arrived at the port of\nBoston\n,\n(City or town.)\non O7 about\n1st\nmass\nCelibe\n(Stato or Territory.)\n,\n(Monthe)\n1923 (Year.)\n1.1.1.12\n(Day.)\nNOTE 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.\nGOVBINMENT PRINTING OFFICE\n14-8"
}