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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4911
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.
Joann Alien should print or typewrite Pomagan here true, original and correct
; age,
37
years.
Miss
name)
(Give age last birthday)
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 steamship ticket was
My mother's maiden name was
My maiden name was (if woman)
My bleacher
present occcupation is
My personal description is: Color, white ; complexion, dark ; height, 5 feet 742 inches;
weight, 185 pounds; color of hair, dark brown ; color of eyes, brown
;
other visible distinctive marks: small moleon left check
I was born in
Cushiwata,
Russia
(City or town)
(Country)
on the 24
day of
My present residence is Oakdale montville Comm
Fibruary
1889
(Number and street)
Oladdle,
or town
(County)
My
post office address is 38, Come (State)
P.O.Box
The place whofe
Germany
I took the ship or train which landed me in the United States was Hambarg
, on
(Month)
(Day)
(Year)
The ticket on which I came to this country was bought at
The name of the ship or railroad on which I came was
President (City) Grant (Country)
(OVER)
014-8
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Document data
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- Core
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4911\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.\nJoann Alien should print or typewrite Pomagan here true, original and correct\n; age,\n37\nyears.\nMiss\nname)\n(Give age last birthday)\nAlso known as\n(If\nalien 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 steamship ticket was\nMy mother's maiden name was\nMy maiden name was (if woman)\nMy bleacher\npresent occcupation is\nMy personal description is: Color, white ; complexion, dark ; height, 5 feet 742 inches;\nweight, 185 pounds; color of hair, dark brown ; color of eyes, brown\n;\nother visible distinctive marks: small moleon left check\nI was born in\nCushiwata,\nRussia\n(City or town)\n(Country)\non the 24\nday of\nMy present residence is Oakdale montville Comm\nFibruary\n1889\n(Number and street)\nOladdle,\nor town\n(County)\nMy\npost office address is 38, Come (State)\nP.O.Box\nThe place whofe\nGermany\nI took the ship or train which landed me in the United States was Hambarg\n, on\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\nThe name of the ship or railroad on which I came was\nPresident (City) Grant (Country)\n(OVER)\n014-8"
}