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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4974
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
(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.
Jozela Grzymala
; age,
42
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
Also
known as gozefa Gamala (If alien has used any
other name in this country, that name should be shown here)
I used that name because it is easier to spell and pronounce
The full name of the person showil on wy steamship ticket was
My mothor D maiden was
My maidon name was (if woman)
My present occcupation is Housewife
My personal description is: Color, white ; complexion, light
; height, 5
feet 3 1/200 inches;
weight, 145 pounds; color of hair, Brown anburn ; color of eyes, blue
;
other Redmark
visible distinctive marks: Birthmark onnose under right side of none
I
was born in Sckwa" Russia, now
(City or town)
(Country)
on the 10th day of april
1884
My present residence is James (Number and ave. street) (City or town) new (County) London Conn (State)
Waterford
My post office address is Waterford, Conn. R.F.D.#2
The place where I took the ship or train which landed me in the United States was Bremew,
Germany
, on October (Month) 29th (Day) 1899 (Year)
The ticket on which I camo to this country was bought at
(City)
(Country)
The name or on
of the ship railroad which I came was Go not remember
(OVER)
e14-8
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Document data
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- Core
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4974\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\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.\nJozela Grzymala\n; age,\n42\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nAlso\nknown as gozefa Gamala (If alien has used any\nother name in this country, that name should be shown here)\nI used that name because it is easier to spell and pronounce\nThe full name of the person showil on wy steamship ticket was\nMy mothor D maiden was\nMy maidon name was (if woman)\nMy present occcupation is Housewife\nMy personal description is: Color, white ; complexion, light\n; height, 5\nfeet 3 1/200 inches;\nweight, 145 pounds; color of hair, Brown anburn ; color of eyes, blue\n;\nother Redmark\nvisible distinctive marks: Birthmark onnose under right side of none\nI\nwas born in Sckwa\" Russia, now\n(City or town)\n(Country)\non the 10th day of april\n1884\nMy present residence is James (Number and ave. street) (City or town) new (County) London Conn (State)\nWaterford\nMy post office address is Waterford, Conn. R.F.D.#2\nThe place where I took the ship or train which landed me in the United States was Bremew,\nGermany\n, on October (Month) 29th (Day) 1899 (Year)\nThe ticket on which I camo to this country was bought at\n(City)\n(Country)\nThe name or on\nof the ship railroad which I came was Go not remember\n(OVER)\ne14-8"
}