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Form 8203 TRIPLICAT No. 135 je the STATES OF Department of Commerce and Tabor BUREAU OF IMMIGRATION AND NATURALIZATION DIVISION OF NATURALIZATION DECLARATION OF INTENTION (Invalid for all purposes seven years after the date hereof) District of Connectiout In the United States Circuit Court SS : County of Dew Haven of said District 3, Simon Berman , aged 24 years, occupation tailor , do declare affirm on oath that my personal description is: Color white complexion dark , height 5. feet 51./Rches, weight 122 pounds, color of hair brown color of eyes brown other visible distinctive marks none : I was born in Moratz, Ruasia. on the 4th day of July anno Domini 883 : I now reside at 93. Washington Ave.1 New Haven, Conn. I emigrated to the United States of America from Southampton, England on the vessel [If the allen arrived otherwise than Philadelphia by vessel, the character of conveyance or name of transportation company should be given.) ; my last foreign residence was London, England It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign prince, potentate, state, or sovereignty, and particularly to Nicholas II Emperor of Russia , of which I am now a titisen subject ; I arrived at the port of New York , in the State Territory of New York on or about the 6 Biotsict day of April , anno Domini I 902 : I am not an anarchist: I am not a polygamist nor a believer in the practice of polygamy: and it is my intentión in good faith to become a citizen of the United States of America and to permanently reside therein: So HELP ME GOD. Semon Beman (Original signature of declarant.) Subscribed and affiemed before me this sworn to 18 day of November , anno Domini 19 07. E Emain By b. E. of the u. s. Cirouit Court. Dp. Clerk. Sub

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Type
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Page context
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    "ocrText": "Form 8203\nTRIPLICAT\nNo.\n135\nje\nthe\nSTATES OF\nDepartment of Commerce and Tabor\nBUREAU OF IMMIGRATION AND NATURALIZATION\nDIVISION OF NATURALIZATION\nDECLARATION OF INTENTION\n(Invalid for all purposes seven years after the date hereof)\nDistrict of Connectiout\nIn the United States Circuit Court\nSS :\nCounty of Dew Haven\nof\nsaid District\n3,\nSimon Berman\n, aged\n24\nyears,\noccupation\ntailor\n, do declare affirm on oath that my personal\ndescription is: Color white\ncomplexion dark\n,\nheight 5. feet 51./Rches,\nweight 122 pounds, color of hair\nbrown\ncolor of eyes\nbrown\nother visible distinctive marks\nnone\n:\nI was born in\nMoratz, Ruasia.\non the\n4th\nday of\nJuly\nanno\nDomini 883 : I now reside at\n93. Washington Ave.1 New Haven, Conn.\nI emigrated to the United States of America from\nSouthampton, England\non the vessel\n[If the allen arrived otherwise than Philadelphia by vessel, the character of conveyance or name of transportation company should be given.) ; my last\nforeign residence was\nLondon, England\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprince, potentate, state, or sovereignty, and particularly to\nNicholas II\nEmperor of Russia\n, of which I am now a titisen subject ;\nI\narrived at the port of\nNew York\n,\nin the\nState\nTerritory of\nNew York\non or about the\n6\nBiotsict\nday\nof\nApril\n,\nanno Domini I 902 : I am not an anarchist: I am not\na\npolygamist nor a believer in the practice of polygamy: and it is my intentión in good faith\nto become a citizen of the United States of America and to permanently reside therein:\nSo HELP ME GOD.\nSemon Beman\n(Original signature of declarant.)\nSubscribed and affiemed before me this\nsworn to\n18\nday of November\n,\nanno Domini 19 07.\nE Emain\nBy b. E. of the u. s.\nCirouit\nCourt.\nDp. Clerk.\nSub"
}