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Form 2218
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4997
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.-- 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.
Oliver (Alien should monlered Regender "age,
monters Brsender
2423
years.
Miss
print or typewrite here true, original, and correet name)
(Give age last birthday)
Also known as
Oliver gomes
(If alien has used any other name in this country, that name should be shown here)
I used
that name because Under Janadam name
The full name of the person shown on my steamship ticket was,
My mother's maiden name was
My malden name was (if woman)
My personal description is: Color, White ; complexion, Wark Brown height, 5 feet 7 1/4
My present occcupation is Foundry Labrare
inches;
weight, 135 pounds; color of hair, Black
; color
of eyes, Dark Browro,
other visible distinctive marks: Pockmarkson nowe halmsofbands
I was born in
15th November
Gengex (City or town)
Cape (Country) lego
on the
day of
, 1 903
My present residence is (Number and street) street Nonvich (City town)
10 geter
boun
or
(County)
(State)
My post office address is the form H Nonvich
Come
The or me in
place where I took the ship train which landed the United States was Capa Verdes Fall find
said st Gevoge
, on June (Month)
/
.
1914
(Day)
(Year)
The ticket on which I came to this country was bought at
Camash
(City)
(Country)
The name of the ship or railroad on which I came was
(ovrn)
e14-8
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Document data
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"ocrText": "Form 2218\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4997\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.-- 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.\nOliver (Alien should monlered Regender \"age,\nmonters Brsender\n2423\nyears.\nMiss\nprint or typewrite here true, original, and correet name)\n(Give age last birthday)\nAlso known as\nOliver gomes\n(If alien has used any other name in this country, that name should be shown here)\nI used\nthat name because Under Janadam name\nThe full name of the person shown on my steamship ticket was,\nMy mother's maiden name was\nMy malden name was (if woman)\nMy personal description is: Color, White ; complexion, Wark Brown height, 5 feet 7 1/4\nMy present occcupation is Foundry Labrare\ninches;\nweight, 135 pounds; color of hair, Black\n; color\nof eyes, Dark Browro,\nother visible distinctive marks: Pockmarkson nowe halmsofbands\nI was born in\n15th November\nGengex (City or town)\nCape (Country) lego\non the\nday of\n, 1 903\nMy present residence is (Number and street) street Nonvich (City town)\n10 geter\nboun\nor\n(County)\n(State)\nMy post office address is the form H Nonvich\nCome\nThe or me in\nplace where I took the ship train which landed the United States was Capa Verdes Fall find\nsaid st Gevoge\n, on June (Month)\n/\n.\n1914\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\nCamash\n(City)\n(Country)\nThe name of the ship or railroad on which I came was\n(ovrn)\ne14-8"
}