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{
    "localId": "159596813",
    "label": "File numbers 4874 - 5509, 1926-1930",
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    "title": "File numbers 4874 - 5509, 1926-1930",
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        "Naturalization Records of Non-Federal Courts in Connecticut",
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{
    "seq": 861,
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    "ocrText": "Form 2213\n5305\nFACTS FOR DECLARATION OF INTENTION\nU. S. DEPARTMENT OF LABOR\nNATURALIZATION SERVICE\naddresstine\nErnest Peters\nNOTE.-A copy of this form will be furnished by the clerk of the court, the Chief Naturalization Examinery or the\npublic-school teacher to each applicant for a declaration of intention, so that he can at his leisure fill in the answers to\nthequestions. After being filled out the form is to be returned to the clerk, to be used by him in properly filling out the\ndeclaration. Care should be used to state as near as can be remembered the day, month, and year of arrival, as well as\nthe name of the vessel on which the alien emigrated to this country.\nTO THE APPLICANT.-The fee 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 fee 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.\nMy name is Gnastasia Anastable ge:\nanastaseos Payagiotory anastaselle\n39\nyears.\n(Alien should state here his true, original, and correct name in full.)\n(Give age at last birthday.)\nAlso known as Ernest Peters\n(If alien has used any other name in this country, that name should be shown on line immediately above.)\nOccupation:\npertaugant Waiter\nColor: Light White\nComplezion: dark\nHeight:\n5-\nfeet 451/2 inches. Weight: 160\npounds.\nColor of hair: Hand Brown\nColor of eyes: Rock Brown\nPaleokipus, Other visible distinctive marks: scar on (If Right visible distinctive marks, band state.) wrist\nSmall-noticn faceants\nno so\nWhere born: (City or town.) Palcohips\nmetylin\nGruce\n(Country.\nDate of birth: July\nCourt 5 (Day.)\n,\n(Month.)\n1888 (Year.\nPresent residence: new finder +-,\n5thrisuld\nConsu\nNumber and street.)\n(City or town.)\n(State, Territory, or District.)\nEmigrated from:\nPatras\n(Place where, alien got on ship or train to come to the United States.)\nquice\n(Country.)\nName of vessel:\nsaid\narrived otherwise than by vessel, Construction the character of conveyance or name Hundred transportation company should) given.)\nLast place of joreign residence:\nCity or town.)\ngand\n(Country.)\n*I\nam - married : the name of my wife is\n;\nwas\n*born at nowLandon, Com and now resides\nsala\nI subject of and intend allegiance to the Greek\nat 15 griguold CE,\nam now a to renounce\nRepublic\n(Write name and title of sovereign and country of which now a subject; or if citizen of a Republic, write name of Republic only.)\nI arrived at the port of\nnew (City or town.)\nyork\n,\non\nor about august (Month.)\n,\n10\n,\n1907\nnot (State york or Territory.)\n(Day.)\n(Vear.)\n*\nNOTE 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."
}