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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4916
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.
1
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.
Manual Roderick.,I.
2526
; age,
years.
Miss
(Alien should print or typewrite here true, original, Ond 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
Rose sile
My maiden name was (if woman)
My present occcupation is Vilurt weare
8 1/2
My personal description is: Color, White complexion, fair dark height, 5 feet inches;
weight, 150 pounds; color of hair, from
darki
; of eyes,
color brown
other visible distinctive marks:
I
was born in Praia Jerecrica, Agou slande, Portugal
(City or town)
(Country
on
the 2d day of Normata
, 1900
My
present residence is 12 Haveof St. Slouington Kww foudon boure
(Number and street)
(City or town)
(County)
(State)
My post office address is 12 Haway St. Stonington Morfonder leome
The place where I took the ship or train which landed me in the United States was
said Praia. Agour Sland
Nov.
2 d 1905
, on
(Month)
(Day)
(Year)
The ticket on which I came to this country was bought at
Praia
Agre reade
The name of the ship or railroad on which I came was
Peninsula (City)
(Country)
(over)
e14-8
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Document data
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- Core
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Context sent to Scholar
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4916\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.\n1\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.\nManual Roderick.,I.\n2526\n; age,\nyears.\nMiss\n(Alien should print or typewrite here true, original, Ond 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\nRose sile\nMy maiden name was (if woman)\nMy present occcupation is Vilurt weare\n8 1/2\nMy personal description is: Color, White complexion, fair dark height, 5 feet inches;\nweight, 150 pounds; color of hair, from\ndarki\n; of eyes,\ncolor brown\nother visible distinctive marks:\nI\nwas born in Praia Jerecrica, Agou slande, Portugal\n(City or town)\n(Country\non\nthe 2d day of Normata\n, 1900\nMy\npresent residence is 12 Haveof St. Slouington Kww foudon boure\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post office address is 12 Haway St. Stonington Morfonder leome\nThe place where I took the ship or train which landed me in the United States was\nsaid Praia. Agour Sland\nNov.\n2 d 1905\n, on\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\nPraia\nAgre reade\nThe name of the ship or railroad on which I came was\nPeninsula (City)\n(Country)\n(over)\ne14-8"
}