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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5169
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
CARD INDEX
upper left-hand corner of all copies of
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.
REGINALD. GILBERT. POTTS
; age,
37
years.
My
present occupation is pipe filter
Miss
(Alien should print er ydeyrite here true, original, and correct name)
(Give age last birthday)
My personal description is: Color, white ; fain
complexion,
; height, 5 feet 5 inches;
weight, 165 pounds; color of hair, light brown
color of blue
other visible distinctive marks: birth mark on ; nose eyes, andrighteyes
;
I was born in
New Nills,
(City or town)
England
(Country)
on the 15
day
of August
My present
residence is 19 Dapinook St genertt town) City, A New (County) Conn (State)
(Number and street)
(City or
The place where I took the ship train which landed in the United States Liverpool
or me was
England
, on
Dhril
26
1904
(Day)
(Year)
The name or on came was
of the ship railroad which I S.E. Ivernia (Month)
My place foreign was
last of residence sand New Mills
(City or town)
England
(Country)
{
wife
married. The name of my
is Lucienne, Path
She
I am
was born at
Woonsocket R.I.
husband
He
, and now resides at genett Stypet City
lonn
,
I am now a subject
of and intend to renounce allegiance to great (Write BritismentKing and title of sovereign and country of which George subject;
name now a
or, if citizen of a republic, write name of republic only)
I arrived at the United States immigration port of
Boston
Mass,
(City or town)
,
(State or territory)
on 4 May (Give exact 1904 month, day,
and year)
(OVER)
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
- 0b5e9ad1dcc95670
- Size
- unknown
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\n5169\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\nCARD INDEX\nupper left-hand corner of all copies of\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.\nREGINALD. GILBERT. POTTS\n; age,\n37\nyears.\nMy\npresent occupation is pipe filter\nMiss\n(Alien should print er ydeyrite here true, original, and correct name)\n(Give age last birthday)\nMy personal description is: Color, white ; fain\ncomplexion,\n; height, 5 feet 5 inches;\nweight, 165 pounds; color of hair, light brown\ncolor of blue\nother visible distinctive marks: birth mark on ; nose eyes, andrighteyes\n;\nI was born in\nNew Nills,\n(City or town)\nEngland\n(Country)\non the 15\nday\nof August\nMy present\nresidence is 19 Dapinook St genertt town) City, A New (County) Conn (State)\n(Number and street)\n(City or\nThe place where I took the ship train which landed in the United States Liverpool\nor me was\nEngland\n, on\nDhril\n26\n1904\n(Day)\n(Year)\nThe name or on came was\nof the ship railroad which I S.E. Ivernia (Month)\nMy place foreign was\nlast of residence sand New Mills\n(City or town)\nEngland\n(Country)\n{\nwife\nmarried. The name of my\nis Lucienne, Path\nShe\nI am\nwas born at\nWoonsocket R.I.\nhusband\nHe\n, and now resides at genett Stypet City\nlonn\n,\nI am now a subject\nof and intend to renounce allegiance to great (Write BritismentKing and title of sovereign and country of which George subject;\nname now a\nor, if citizen of a republic, write name of republic only)\nI arrived at the United States immigration port of\nBoston\nMass,\n(City or town)\n,\n(State or territory)\non 4 May (Give exact 1904 month, day,\nand year)\n(OVER)"
}