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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5175
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
NATURALIZATION SERVICE
36338
Place number
in
RECEIVED
CARD INDEX
upper left-hand corner of all copies of
declaration, immediately under your
INDEX BOOKS
AUG 5 1927
declaration number.
DISTRICT DIRECTOR OF NATURALIZATION
MANIFESTS
us
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
SAM KERSHAW
; age,
29.
years.
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
My present occupation is
Machinest.
My personal description is: Color, White ; complexion,
Freak far ;
10
height,
5 feet of inches;
weight, 164. pounds; color of hair, Brown.
; color of eyes,
AU OM
;
other visible distinctive marks:
Scarson backofneck rightfor RHCKIVAD
Helenahand
I was born in
WAlayield (City or town) Mookohine
England
8 1 1927 M.
(Countryoner
on the
30
day of
January
, 1098
My present residence is
11 Dears St
Graton
Connecticut
(Number and street)
(City or town)
(County)
(State)
The place where I took the ship or train which landed me in the United States was
Sivespool
England.
,on Rhousmber.
26th.
1976
(Month)
(Day)
(Year)
The name of the ship or railroad on which I came was S.S. Cedrig
White Stas Line
My last place of foreign residence was
Cantteford
Jorholine
(City of town)
(Country)
England
wife
married. The name of my
Mary alies Hershaw
She
I am
is
was born at
youthster
paid Cartleford England
,
and now resides at said droton HI Decome connecticut
am now a subject of and intend to renounce allegiance to
George v. by the Grace of God. of Grea' B* ta n,
King Write Sengety and title of soyereign and England of which
name country now a subject;
Ireland, and the Brttsh Dom nons beyond the Seas
King. Defender of the farth € imperor et tacker
or, if citizen of a republic, write name of republic only)
I arrived at the United States immigration port of
Bostoy
(City or town)
Mass.
,
(State or territory)
on 1926
17-8
(Give exact month, day, and year)
(OVER)
can
SEP 30 1927
Page data
- Page
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- Source index
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- Type
- photo
- Media ID
- 16c4b9d50a94fae6
- Size
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Document data
- ID
- 159596813
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5175\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\nNATURALIZATION SERVICE\n36338\nPlace number\nin\nRECEIVED\nCARD INDEX\nupper left-hand corner of all copies of\ndeclaration, immediately under your\nINDEX BOOKS\nAUG 5 1927\ndeclaration number.\nDISTRICT DIRECTOR OF NATURALIZATION\nMANIFESTS\nus\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nSAM KERSHAW\n; age,\n29.\nyears.\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nMy present occupation is\nMachinest.\nMy personal description is: Color, White ; complexion,\nFreak far ;\n10\nheight,\n5 feet of inches;\nweight, 164. pounds; color of hair, Brown.\n; color of eyes,\nAU OM\n;\nother visible distinctive marks:\nScarson backofneck rightfor RHCKIVAD\nHelenahand\nI was born in\nWAlayield (City or town) Mookohine\nEngland\n8 1 1927 M.\n(Countryoner\non the\n30\nday of\nJanuary\n, 1098\nMy present residence is\n11 Dears St\nGraton\nConnecticut\n(Number and street)\n(City or town)\n(County)\n(State)\nThe place where I took the ship or train which landed me in the United States was\nSivespool\nEngland.\n,on Rhousmber.\n26th.\n1976\n(Month)\n(Day)\n(Year)\nThe name of the ship or railroad on which I came was S.S. Cedrig\nWhite Stas Line\nMy last place of foreign residence was\nCantteford\nJorholine\n(City of town)\n(Country)\nEngland\nwife\nmarried. The name of my\nMary alies Hershaw\nShe\nI am\nis\nwas born at\nyouthster\npaid Cartleford England\n,\nand now resides at said droton HI Decome connecticut\nam now a subject of and intend to renounce allegiance to\nGeorge v. by the Grace of God. of Grea' B* ta n,\nKing Write Sengety and title of soyereign and England of which\nname country now a subject;\nIreland, and the Brttsh Dom nons beyond the Seas\nKing. Defender of the farth € imperor et tacker\nor, if citizen of a republic, write name of republic only)\nI arrived at the United States immigration port of\nBostoy\n(City or town)\nMass.\n,\n(State or territory)\non 1926\n17-8\n(Give exact month, day, and year)\n(OVER)\ncan\nSEP 30 1927"
}