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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5269
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
42493 in
they
YED
upper left-hand corner of all copies of
CARD INDEX
declaration, immediately under your
INDEX BOOKS
EAN 80 1928
declaration number.
OF EXAMINER
DISTRICT DIRECTOR OF NATURALIZATION
MANIFESTS
NEW BAVAN, CONN.
or LABOR
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
SAMUEL HADFIELD
; age,
A-AL
25
1922
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
My present occupation is
BLACK DYER
WHITE
My personal description is: Color, 8902
; complexion,
FAIR
;
height, 5 feet $7 inches;
1/2
weight, 143 pounds; color of hair, AUBURN
; color of eyes,
BROWN
;
other visible distinctive marks:
NONE
I was born in
BOLTON ,
LANCASHIRE (ENGLAND)
(City/or town)
(Country)
on the
15TH
day of
JANUARY
1903
PAWCATUCK) CONN.
Commony
My present residence
is 47 LIBERTY STREET, WESTEREY
(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
LIVER DOOL
ANCASHIRE
ENGLAND.
APRIL
3rd
, on
1926
(Month)
(Day)
(Year)
The name of the ship or railroad on which I came was
S.S. SAMARIA
My last place of foreign
residence was 67 BOLTON
said
HAMPOEN St,
(City or town)
(Comngy)
I am NOT married. The name of my
{
wife
She
is
husband
He
}
was born at
-
and now resides at
,
Isam now a subject of and intend to renounce allegiance to
KING GEORGE V
(Write name and title of sovereign and country of which now a subject;
or, if citizen of a republic, write name of republic only)
I arrived at the United States immigration port of
BOSTON
(City or town)
MASS
, on ADRIL 12TH 1926
(State or territory)
14-8
(Give exact month, day, and year)
(OVER)
C/A ISSUET
JA1, 26 1923
Page data
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- Source index
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- Type
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- Size
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Document data
- ID
- 159596813
- Core
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- Type
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DTO data
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Context sent to Scholar
Document identity
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Document source metadata
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5269\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\n42493 in\nthey\nYED\nupper left-hand corner of all copies of\nCARD INDEX\ndeclaration, immediately under your\nINDEX BOOKS\nEAN 80 1928\ndeclaration number.\nOF EXAMINER\nDISTRICT DIRECTOR OF NATURALIZATION\nMANIFESTS\nNEW BAVAN, CONN.\nor LABOR\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nSAMUEL HADFIELD\n; age,\nA-AL\n25\n1922\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nMy present occupation is\nBLACK DYER\nWHITE\nMy personal description is: Color, 8902\n; complexion,\nFAIR\n;\nheight, 5 feet $7 inches;\n1/2\nweight, 143 pounds; color of hair, AUBURN\n; color of eyes,\nBROWN\n;\nother visible distinctive marks:\nNONE\nI was born in\nBOLTON ,\nLANCASHIRE (ENGLAND)\n(City/or town)\n(Country)\non the\n15TH\nday of\nJANUARY\n1903\nPAWCATUCK) CONN.\nCommony\nMy present residence\nis 47 LIBERTY STREET, WESTEREY\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\nLIVER DOOL\nANCASHIRE\nENGLAND.\nAPRIL\n3rd\n, on\n1926\n(Month)\n(Day)\n(Year)\nThe name of the ship or railroad on which I came was\nS.S. SAMARIA\nMy last place of foreign\nresidence was 67 BOLTON\nsaid\nHAMPOEN St,\n(City or town)\n(Comngy)\nI am NOT married. The name of my\n{\nwife\nShe\nis\nhusband\nHe\n}\nwas born at\n-\nand now resides at\n,\nIsam now a subject of and intend to renounce allegiance to\nKING GEORGE V\n(Write name and title of sovereign and country of which now a subject;\nor, if citizen of a republic, write name of republic only)\nI arrived at the United States immigration port of\nBOSTON\n(City or town)\nMASS\n, on ADRIL 12TH 1926\n(State or territory)\n14-8\n(Give exact month, day, and year)\n(OVER)\nC/A ISSUET\nJA1, 26 1923"
}