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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4877
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.
Mrs.
BENSAMIN DCHLEIFER
25
My name is
; age,
years.
Miss
(Alien should print or typewrite here true, original, and correct 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
present occcupation is Solesman
9 Y4
My personal description is: Color white dark : height 5 feet 8
; complexion,
inches;
weight, 185 pounds; color of hair, Bee
dark Brown
; color of eyes,
other visible distinctive marks:
none
A
;
I was born
in Dakshich, Russia, now Poland
(City or town)
(Country)
present on the residence is day Prescribed of City new Ronder 1 Communication
13
1901
My
(City or town)
My post office address is 139 Nonvish County) Can (State)
P.O.B.
(Number and "treet)
The or me was
place where I took the ship train which landed in the United States Kineport
England
on Och
,
1913
The ticket on which I came to this country was bought at Liban (Month)
Russes
(Year)
The name of the ship or railroad on which I came was
manion (City)
(Country)
(OVER)
014-8
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- Type
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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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Page context
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4877\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.\nMrs.\nBENSAMIN DCHLEIFER\n25\nMy name is\n; age,\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nAlso known as\n(If alien 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\npresent occcupation is Solesman\n9 Y4\nMy personal description is: Color white dark : height 5 feet 8\n; complexion,\ninches;\nweight, 185 pounds; color of hair, Bee\ndark Brown\n; color of eyes,\nother visible distinctive marks:\nnone\nA\n;\nI was born\nin Dakshich, Russia, now Poland\n(City or town)\n(Country)\npresent on the residence is day Prescribed of City new Ronder 1 Communication\n13\n1901\nMy\n(City or town)\nMy post office address is 139 Nonvish County) Can (State)\nP.O.B.\n(Number and \"treet)\nThe or me was\nplace where I took the ship train which landed in the United States Kineport\nEngland\non Och\n,\n1913\nThe ticket on which I came to this country was bought at Liban (Month)\nRusses\n(Year)\nThe name of the ship or railroad on which I came was\nmanion (City)\n(Country)\n(OVER)\n014-8"
}