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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5160
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
upper left-hand corner of all copies of
CARD INDEX
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.
Lenora
; age,
3637
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
My present occupation is Housewife
My personal description is: Color, White: complexion, rain
; height, 5 feet
43
4
inches;
weight, 135 pounds; color of hair, Brown
; color of eyes,
Brown
;
other visible distinctive marks: Scoronleftebut
I was born in (City December town) Germany, now Poland (Country)
Jockgort
or
on the 28
day of
,
1 890 Hossold
My present residence is soule Street New London (County) (State) Conn.
Jereritity
(Number and street)
(City or town)
The place where I took the ship or train which landed me in the United States was
Hamburg
Germany
on September (Month)
9
1904
(Day)
(Year)
The name or on came was
of the ship railroad which Ranger I Rajzer Wishem
My last place of foreign residence was, City or town)
said focsgoock
is Joseph ylowacki,
Psland (Country) She Jozef
wife
I am
married. The name of my
was born at
He
Boland Norzicga, 1, and now resides at
Conno
Poland standbould street
I am now a subject of and intend to renounce allegiance to
(Write name and title of sovereign and country of which now a subject;
or, if citizen of a republic, write name of republic only)
I arrived at the United States immigration port of
new york
N.4.
(City or town)
,
on 1+-8 (Give exact month, 9 day, and year) 1904
(State or territory)
September
(OVER)
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
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- Size
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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\n5160\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\nupper left-hand corner of all copies of\nCARD INDEX\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.\nLenora\n; age,\n3637\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nMy present occupation is Housewife\nMy personal description is: Color, White: complexion, rain\n; height, 5 feet\n43\n4\ninches;\nweight, 135 pounds; color of hair, Brown\n; color of eyes,\nBrown\n;\nother visible distinctive marks: Scoronleftebut\nI was born in (City December town) Germany, now Poland (Country)\nJockgort\nor\non the 28\nday of\n,\n1 890 Hossold\nMy present residence is soule Street New London (County) (State) Conn.\nJereritity\n(Number and street)\n(City or town)\nThe place where I took the ship or train which landed me in the United States was\nHamburg\nGermany\non September (Month)\n9\n1904\n(Day)\n(Year)\nThe name or on came was\nof the ship railroad which Ranger I Rajzer Wishem\nMy last place of foreign residence was, City or town)\nsaid focsgoock\nis Joseph ylowacki,\nPsland (Country) She Jozef\nwife\nI am\nmarried. The name of my\nwas born at\nHe\nBoland Norzicga, 1, and now resides at\nConno\nPoland standbould street\nI am now a subject of and intend to renounce allegiance to\n(Write name and title of sovereign and country of which now a subject;\nor, if citizen of a republic, write name of republic only)\nI arrived at the United States immigration port of\nnew york\nN.4.\n(City or town)\n,\non 1+-8 (Give exact month, 9 day, and year) 1904\n(State or territory)\nSeptember\n(OVER)"
}