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{
    "localId": "159596813",
    "label": "File numbers 4874 - 5509, 1926-1930",
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    "contentType": "document",
    "title": "File numbers 4874 - 5509, 1926-1930",
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        "Naturalization Records of Non-Federal Courts in Connecticut",
        "Applications for Declaration of Intention"
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{
    "seq": 707,
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    "ocrText": "5228\nClers of Court:\nForm SATURALIZ ATION SERVICE aber\n16226\nin\nupper\nleft-hasd\ncorneg\nRECELVAD'EACTS FOR DECLARATION OF INTENTION\nDietriot Direster of Naturalization,\nDEC 5 1925\nBoston, Mass\nFROM\nU.S. OF\nDEPARTMENT LABOR RGE E PARSONS\nÓFFICE OF EXAMINER\nNEW HAVEN, CONN.\nNATURALIZATION SERVICE\nCLERK OF THE SUPERIOR COURT\nBEPARTMENT OF LABOR\nNORWICH. CONN\nNOTE.-A copy of this form will be furnished by the clerk of the court, the Chief Naturalization Examiner, or the\npublic-schoo! teacher to each applicant for a declaration of intention, so that he can at his leisure fill in the answers to\nthe questions. After being filled out the applicant should tako the form to the office of the clerk of court to be used\nby him in properly filling out the declaration. Care should be used to state as near as can be remembered the day,\nmonth, and year of arrival, as well as the name of the vessel on which the alien emigrated to this country.\nTO THE APPLICANT.-The feo of one dollar required by law for the declaration, must be paid to the clerk of the\ncourt before he commences to fill out the declaration of intention. No feo is chargeable for this blank, and none\nshould be paid for assistance in filling it out, as the Naturalization Examiner or the public-school teacher will help you\nfree of charge.\n28\nMy name is\nhella Viola Gackz\nAge:\n26\nyears.\n(Alien should state here his true, original, and correct name in full.)\n(Give age at last birthday.)\nAlso known as\n(If alien has used any other name in this country, that name should be shown on line immediately aboved)\nOccupation:\nWhite\nmsedwa Housewife\nColor:\nComplexion:\nFair\nHeight:\nFrie\n61/2\nfeet\ninches. Weigh 134 pounds.\nColor of hair:\nBlond Light Color of Gray\nOther visible distinctive\nmarks: Scaron (II visible eyes: disticcive marks, again state\nCalidonia\nno so\nWhere born: Online\nCanada\n(City or town.)\n(Country.)\nDate of birth:\nSeventh\n1899\nnorwich's late Hos (Month Briston Connecticut\n(Year.)\nPresent residence:\n2\n(Number and street.)\n-\n(City or town.)\n(State, Territory, or District.)\nEmigrated from:\nEdmostan alberta Canada\n(Placo where alien got on ship or train to come to the United States.)\n(Country.)\nName of vessel:\n(If the allen conveyance company be\narrived Canadian atherwise than by vessel, the character Pacific of or name of transportation Railway should given.)\nsard\nLast place of foreign residence:\nEdmonton\nalberta Can\n(City or town.)\n(Country.)\n*I am\nmarried; the name of my hrisbands wife is 11216 the fohe\nwas\n*born at Red bleer, alla now resides saidhopsich at state Hosp., nonwich\nfor the Insane subject of intend allegiance George V2\nam now a and to renounce to\nKing (Write and title of of/sovereign Great and country of which Britain subject; if citizen of and Republics Ireland Republiconi\nname now a or a WI ito name of\nI arrived at the port of\n,\nstermant\n(City or town.)\n(State or Territory.)\non O7 about\nmay\n, Minth8,\n1925\n(Month.)\n(Day.)\n(Year.)\n* NOTE TO CLERK OF COURT.-The two lines indicated by the * contain information which is provided for by blanks on the latest\ndeclaration of intention form; until such time as you may be supplied with forms containing these blank spaces the information called\nfor herein should be inserted immediately ABOVE the twelfth line, which begins It is my bona fide intention,' etc., as requested in\ncircular letter of January 5, 1916.\nC/A issued\nGOVERNMENT PRINTING OFFICE\n14\nFEB 8 1926"
}