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Form 2213 PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN 4903 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 (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. Celia Mindel ; age, $37 years. Miag (Alien should print or typewrite here true, original, and correct name) (Give age last Also known as (If alien has used any other name in this country, that name should be shown here) I used that name because The full name of the person shown on my steamehip ticket was, My mother maiden name was My maiden name was (if woman) My present occcupation is house-wifz My personal description is: Color, White ; fair Dark complexion, brown black ; height, 4c feet 11 inches; weight, 130 pounds; color of hair, ; color of eyes, Blue ; other visible distinctive marks: none I was born in Klubika Russia (City or town) (Country) on the 2d day of September 1 889 My present residence is Bogjah, , Bozrahvilley New London Conn. (Number and street) (City or town) (County) (State) My post office address is Bozrahville, Connecticut The place where I took the ship or train which landed me in the United States was Antwerp, Holland on July 11 1910 (Month) (Day) (Year) The ticket on which I came to this country was bought at The name of the or on came was ship railroad which I Crowland (City) be Gutland Kroonland (Country) (OVER) 614-8

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    "ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4903\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\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.\nCelia Mindel\n;\nage, $37 years.\nMiag\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last\nAlso known as\n(If alien has used any other name in this country, that name should be shown here)\nI used that name because\nThe full name of the person shown on my steamehip ticket was,\nMy mother maiden name was\nMy maiden name was (if woman)\nMy present occcupation is\nhouse-wifz\nMy personal description is: Color, White ;\nfair\nDark complexion, brown black\n; height, 4c feet 11 inches;\nweight, 130 pounds; color of hair,\n; color of eyes,\nBlue\n;\nother visible distinctive marks:\nnone\nI was born in Klubika\nRussia\n(City or town)\n(Country)\non the 2d\nday of September\n1 889\nMy present residence is\nBogjah,\n,\nBozrahvilley\nNew London\nConn.\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post office address is Bozrahville, Connecticut\nThe place where I took the ship or train which landed me in the United States was\nAntwerp, Holland\non\nJuly\n11\n1910\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\nThe name of the or on came was\nship railroad which I Crowland (City) be Gutland Kroonland (Country)\n(OVER)\n614-8"
}