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File numbers 4874 - 5509, 1926-1930

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Form 2213 PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN 5044 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 upper left-hand corner of all copies of CARD INDEX declaration, immediately under your INDEX BOOKS declaration number. DISTRICT DIRECTOR OF NATURALIZATION MANIFESTS Scgehan I desire to file my Declaration of Intention (first paper) to become a citizen. Mr. My name is Mrs. / Stephan (Alien should print typewrite here Stoklosa true, original, and correct ; age, 3/ years. Miss or name) (Give age last birthday) My present occupation is weaver My personal description is: Color, white ; complexion, dark ; height, 5 feet 10 inches; weight, 190 pounds; color ot hair. darkbown color of eyes, darkbrown other visible distinctive marks: I was born in Galicla now Poland (City or town) (Country) My present residence is 13 Terrace Are Jaffnilli (County) Around (State) Comm on the Jan day of 3rd , 896 Artwich (Number and street) (City or town) / The place where I took the ship train which landed in the United States Fryject or me was Trisite austria P , on 14 1912 The name of the ship or railroad on which I came was said My last place of foreign residence was Dombrowa (Month) Wachington Poland (Day) (Year) X (City or town) (Country) , am yes married. The name of my { wife husband } is Anaryaffalusial He She was born at , and now resides at on I am now a subject of and intend to renounce allegiance to Paland (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) , on 14-8 (Give exact month, day, 6, and 19/2 year) (State or territory) February (OVER)

Page data

Page
341
Source index
0
Type
photo
Media ID
224f1856cb176c02
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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    "ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5044\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\nupper left-hand corner of all copies of\nCARD INDEX\ndeclaration, immediately under your\nINDEX BOOKS\ndeclaration number.\nDISTRICT DIRECTOR OF NATURALIZATION\nMANIFESTS\nScgehan\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\n/\nStephan (Alien should print typewrite here Stoklosa true, original, and correct\n; age,\n3/\nyears.\nMiss\nor name)\n(Give age last birthday)\nMy present occupation is\nweaver\nMy personal description is: Color, white ; complexion, dark\n; height, 5 feet 10\ninches;\nweight, 190 pounds; color ot hair. darkbown color of eyes, darkbrown\nother visible distinctive marks:\nI\nwas born in Galicla now Poland\n(City or town)\n(Country)\nMy present residence is 13 Terrace Are Jaffnilli (County) Around (State) Comm\non the Jan day of\n3rd\n, 896 Artwich\n(Number and street)\n(City or town)\n/\nThe place where I took the ship train which landed in the United States Fryject\nor me was\nTrisite austria\nP\n,\non\n14\n1912\nThe name of the ship or railroad on which I came was\nsaid\nMy last place of foreign residence was\nDombrowa\n(Month) Wachington Poland (Day) (Year)\nX\n(City or town)\n(Country)\n, am yes married. The name of my\n{\nwife\nhusband\n}\nis Anaryaffalusial He She\nwas born at\n,\nand\nnow\nresides\nat\non\nI am now a subject of and intend to renounce allegiance to\nPaland\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 (City\nor town)\n,\non 14-8 (Give exact month, day, 6, and 19/2 year)\n(State or territory)\nFebruary\n(OVER)"
}