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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5020
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.
Boleslaw Cieslukowski
; age,
33
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
Also known as
(If alien has used any other name in this country, that name should be shown here)
I used that name because
The full name of the person shown on my steamship ticket was Boleslaw Cieslukowski
My mother's maiden name was Magdalena Tarszkiewicz
My maiden name was (if woman)
My present occcupation is polisher
83/4
My personal description is: Color, white
; complexion, dark
; height, 5 feet 8 inches;
weight,
155 pounds; color of hair, brown ; color of eyes, gray
dark
other visible distinctive marks: none
I was born in
frzywulka, Toland Russia, now Poland
Smallecaron for theak
(City or town)
(Country)
the 10
December
893
on
day of
,1
My present residence is 110 Summit str, Norwich, Conn.
(Number and street)
(City or town)
(County)
(State)
same as above
My post office address is
The place where I took the ship or train which landed me in the United States was
Antwerp, Belgium
on May 19, 1914
,
(Month)
(Day)
(Year)
The ticket on which I came to this country was bought at Belgium, Antwerp
(City)
(Country)
The name of the ship or railroad on which I came was Norland,
(OVER)
014-8
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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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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5020\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.\nBoleslaw Cieslukowski\n; age,\n33\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nAlso known as\n(If alien has used any other name in this country, that name should be shown here)\nI used that name because\nThe full name of the person shown on my steamship ticket was Boleslaw Cieslukowski\nMy mother's maiden name was Magdalena Tarszkiewicz\nMy maiden name was (if woman)\nMy present occcupation is polisher\n83/4\nMy personal description is: Color, white\n; complexion, dark\n; height, 5 feet 8 inches;\nweight,\n155 pounds; color of hair, brown ; color of eyes, gray\ndark\nother visible distinctive marks: none\nI was born in\nfrzywulka, Toland Russia, now Poland\nSmallecaron for theak\n(City or town)\n(Country)\nthe 10\nDecember\n893\non\nday of\n,1\nMy present residence is 110 Summit str, Norwich, Conn.\n(Number and street)\n(City or town)\n(County)\n(State)\nsame as above\nMy post office address is\nThe place where I took the ship or train which landed me in the United States was\nAntwerp, Belgium\non May 19, 1914\n,\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at Belgium, Antwerp\n(City)\n(Country)\nThe name of the ship or railroad on which I came was Norland,\n(OVER)\n014-8"
}