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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5186
U. S. DEPARTMENT OF LABOR
NOT TO BE FILLED IN BY ALIEN
NATURALIZATION SERVICE
FOR USE OF OFFICIALS SEARCHING IMMI-
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
Canton meoduszewski i
I desire to file my Declaration of Intention (first paper) to become a cibizion.
Mr.
Mrs.
antom Miodusguister
33
My name is
; age,
years.
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
My present occupation is Labour
Miss
My personal description is: Color, White ; complexion, fair
5
& 744
; height,
feet
inches;
weight, 162 pounds; color of hair, Brown ; color of eyes, Blue
;
left was born in fortunger recent (City or town)
other visible distinctive marks: Scarsat baseofs left thumbandon
I
on the
23
September
, 1 Valendish (Country)
Box 102
day of
residence is 6 time (Number and street) Sewerth (City town) (Counts
Cann
My present
or
(State)
The place where I took the
Halifax, Novascotia , on
ship or traim which landed me in the United States was 1913
May
(Month)
(Day)
(Year)
The name of the ship or railroad on which I came was National Railway
My last place of foreign residence
said was
Sucgna
foland
(City or town)
I am
{
wife
married. The name of my
is
Julig (Country)
She
was born at
hushand
He
Boleslan, Poland
and now resides
said6 at A Dime st fearts City Caces
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 Refundlin only) of Palaud Vancbow
I arrived at the United States immigration port of
(City or town)
maine
(State or territory)
, on June 5 14-8 (Give exact month, 1913 day, and
year)
(OVER)
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Document data
- ID
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- Core
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- Type
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DTO data
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5186\nU. S. DEPARTMENT OF LABOR\nNOT TO BE FILLED IN BY ALIEN\nNATURALIZATION SERVICE\nFOR USE OF OFFICIALS SEARCHING IMMI-\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\nCanton meoduszewski i\nI desire to file my Declaration of Intention (first paper) to become a cibizion.\nMr.\nMrs.\nantom Miodusguister\n33\nMy name is\n; age,\nyears.\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nMy present occupation is Labour\nMiss\nMy personal description is: Color, White ; complexion, fair\n5\n& 744\n; height,\nfeet\ninches;\nweight, 162 pounds; color of hair, Brown ; color of eyes, Blue\n;\nleft was born in fortunger recent (City or town)\nother visible distinctive marks: Scarsat baseofs left thumbandon\nI\non the\n23\nSeptember\n, 1 Valendish (Country)\nBox 102\nday of\nresidence is 6 time (Number and street) Sewerth (City town) (Counts\nCann\nMy present\nor\n(State)\nThe place where I took the\nHalifax, Novascotia , on\nship or traim which landed me in the United States was 1913\nMay\n(Month)\n(Day)\n(Year)\nThe name of the ship or railroad on which I came was National Railway\nMy last place of foreign residence\nsaid was\nSucgna\nfoland\n(City or town)\nI am\n{\nwife\nmarried. The name of my\nis\nJulig (Country)\nShe\nwas born at\nhushand\nHe\nBoleslan, Poland\nand now resides\nsaid6 at A Dime st fearts City Caces\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\nrepublic Refundlin only) of Palaud Vancbow\nI arrived at the United States immigration port of\n(City or town)\nmaine\n(State or territory)\n, on June 5 14-8 (Give exact month, 1913 day, and\nyear)\n(OVER)"
}