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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5464
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
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
Piotr Mrosz
; age,
34
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
My present occupation is
truckman
My personal description is: Color, White ; complexion, Light
; height,
5 feet 31/2 inches;
weight, 150 pounds; color of hair,
Golden Blonde
?
F
; color of eyes,
Blue
;
other visible distinctive marks:
Scar on back of right hand
I was born in
Delewo
Russia now Poland
(City or town)
(Country)
on the
1st of
day
November
1894
My present residence is
III North Bank St. NewLondon, New London Conn.
(Number and street)
(City or town)
(County)
(Stats)
The place where I took the ship or train which landed me in the United States was
Rotterdam, Holland
orabour
, on
August
14 Th 1913
(Month)
(Day)
(Year)
The name of the ship or railroad on which I came was
Noordam (manifest 28/11)
My last place of foreign residence was
Dauge Kontt Russia now Poland
(City or town)
(Country)
wife
I am - married. The name of my
is Ksawera
She
husband
the
}
was born at
Austria
, and now
resides at New London Conn.
I
am now a subject of and intend to renounce allegiance to
The Republic of Poland
(Write name and title of sovereign and country of which now a subject;
or, if citizen of a republic, write name of republic only)
I arrived at the United States immigration port of
New York
(City or town)
New (State teritory) york
, on
or
11-8
august (Give exact month, day, 25 and year) 1913
(OVER)
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
- 42956139e11a3318
- Size
- unknown
Document data
- ID
- 159596813
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
Document identity
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Document source metadata
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Page context
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5464\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\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nPiotr Mrosz\n; age,\n34\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nMy present occupation is\ntruckman\nMy personal description is: Color, White ; complexion, Light\n; height,\n5 feet 31/2 inches;\nweight, 150 pounds; color of hair,\nGolden Blonde\n?\nF\n; color of eyes,\nBlue\n;\nother visible distinctive marks:\nScar on back of right hand\nI was born in\nDelewo\nRussia now Poland\n(City or town)\n(Country)\non the\n1st of\nday\nNovember\n1894\nMy present residence is\nIII North Bank St. NewLondon, New London Conn.\n(Number and street)\n(City or town)\n(County)\n(Stats)\nThe place where I took the ship or train which landed me in the United States was\nRotterdam, Holland\norabour\n, on\nAugust\n14 Th 1913\n(Month)\n(Day)\n(Year)\nThe name of the ship or railroad on which I came was\nNoordam (manifest 28/11)\nMy last place of foreign residence was\nDauge Kontt Russia now Poland\n(City or town)\n(Country)\nwife\nI am - married. The name of my\nis Ksawera\nShe\nhusband\nthe\n}\nwas born at\nAustria\n, and now\nresides at New London Conn.\nI\nam now a subject of and intend to renounce allegiance to\nThe Republic of Poland\n(Write name and title of sovereign and country of which now a subject;\nor, if citizen of a republic, write name of republic only)\nI arrived at the United States immigration port of\nNew York\n(City or town)\nNew (State teritory) york\n, on\nor\n11-8\naugust (Give exact month, day, 25 and year) 1913\n(OVER)"
}