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Form 2208
No. 1996.
TRIPLICATE
the person
the Declaration]
STATES OF
Department of Commerce and Tahnr
BUREAU OF IMMIGRATION AND NATURALIZATION
DIVISION OF NATURALIZATION
DECLARATION OF INTENTION
(Invalid for all purposes seven years after the date hereof)
STATE OF
In
the SUPERIOR
County of Los Angeles
Court
SS :
THE BTAT# or CALIFORNIA
of
IN AND FOR Les ANGELES COUNTY,
3.
Samuel Levin
aged
21
years,
occupation
Failon
do declare affiren. on that my personal
oath
description is: Color white , complexion Dark height Teet 4. inches,
weight 126 pounds, color of hair Black , color of eyes
Brown
other visible distinctive marks
none
: born in Ecatarinoruan
I was
Russia
on the
5'
day of
June
anno
Domini I 888 I now reside at
Las Anyrles bad
I emigrated to the United States of America from Libe Russing
on the vessel [If the allen arrived Peterbury
my last
character of conveyance or namegt transportation company should be given.)
foreign
residence was Ecocarinosuan aussia
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 citicen- subject I
arrived at the port of
nevyork
in the
State
Tezsitory of
mevyork
on or about the
76. day
District
of
August
, anno Domini 1907; I am not an anarchist; I am not a
polygamist nor a believer in the practice of polygamy; and it is my intention in good faith
to become a citizen of the United States of America and to permanently reside therein
So HELP ME GOD.
Samuel Levin
(Original signature of declarant.)
Subscribed and affirmed sworn to before me this
27th
[SEAL.
day of December
anno Domini 19 09
O. G. Keyes
COUNTY CLERK AND EX-OFFICIO
OF
THE SUPERIOR COURT IN AND FOR THE oour
Clerk of the or LOO ANGELES STA OF Cour
By
givenday arputy Clerk
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Document data
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- Core
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- Type
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DTO data
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Context sent to Scholar
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Document source metadata
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Page context
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"ocrText": "Form 2208\nNo. 1996.\nTRIPLICATE\nthe person\nthe Declaration]\nSTATES OF\nDepartment of Commerce and Tahnr\nBUREAU OF IMMIGRATION AND NATURALIZATION\nDIVISION OF NATURALIZATION\nDECLARATION OF INTENTION\n(Invalid for all purposes seven years after the date hereof)\nSTATE OF\nIn\nthe SUPERIOR\nCounty of Los Angeles\nCourt\nSS :\nTHE BTAT# or CALIFORNIA\nof\nIN AND FOR Les ANGELES COUNTY,\n3.\nSamuel Levin\naged\n21\nyears,\noccupation\nFailon\ndo declare affiren. on that my personal\noath\ndescription is: Color white , complexion Dark height Teet 4. inches,\nweight 126 pounds, color of hair Black , color of eyes\nBrown\nother visible distinctive marks\nnone\n: born in Ecatarinoruan\nI was\nRussia\non the\n5'\nday of\nJune\nanno\nDomini I 888 I now reside at\nLas Anyrles bad\nI emigrated to the United States of America from Libe Russing\non the vessel [If the allen arrived Peterbury\nmy last\ncharacter of conveyance or namegt transportation company should be given.)\nforeign\nresidence was Ecocarinosuan aussia\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nprince, potentate, state, or sovereignty, and particularly to nicholas II\nEmperor of Russia\nof which I am now a citicen- subject I\narrived at the port of\nnevyork\nin the\nState\nTezsitory of\nmevyork\non or about the\n76. day\nDistrict\nof\nAugust\n, anno Domini 1907; I am not an anarchist; I am not a\npolygamist nor a believer in the practice of polygamy; and it is my intention in good faith\nto become a citizen of the United States of America and to permanently reside therein\nSo HELP ME GOD.\nSamuel Levin\n(Original signature of declarant.)\nSubscribed and affirmed sworn to before me this\n27th\n[SEAL.\nday of December\nanno Domini 19 09\nO. G. Keyes\nCOUNTY CLERK AND EX-OFFICIO\nOF\nTHE SUPERIOR COURT IN AND FOR THE oour\nClerk of the or LOO ANGELES STA OF Cour\nBy\ngivenday arputy Clerk"
}