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Form 2218
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4895
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.
LUKASI LUPA
; age, 38.
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
Also known as
no
(If alien has used any other name in this country, that name should be shown here)
I used that name because no
The full name of the person shown on my steamship ticket was,
My mothor's maiden name wasm
My maiden name was (if woman)
My present occcupation is Fireman,
My personal description 150 is: Color, color white of brown ; complexion, fair
; height, 5 feet 7 inches;
weight,
pounds;
hair,
; eyes,
color of blue
;
other visible distinctive marks:
none
I was
born in Chubenice austria; now Poland.
on the 13 & day of
October
(Country)
Giswold
1 1888
My present residence is aleaventh (Number and City street) Com (City town) Newlondon, (County) 1182 (State)
or
My
The place where I tock the ship or train which landed me in the United States was Hamblrg
post office address is BX 1182, 9 City
gawett
, on March,
12
19.10
(Month)
(Day)
(Year)
The ticket on which I came to this country was bought at
The name of the ship or railroad on which I came was Everydent (City) grand. (Country)
(OVER) President Grant
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"ocrText": "Form 2218\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4895\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.\nLUKASI LUPA\n; age, 38.\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nAlso known as\nno\n(If alien has used any other name in this country, that name should be shown here)\nI used that name because no\nThe full name of the person shown on my steamship ticket was,\nMy mothor's maiden name wasm\nMy maiden name was (if woman)\nMy present occcupation is Fireman,\nMy personal description 150 is: Color, color white of brown ; complexion, fair\n; height, 5 feet 7 inches;\nweight,\npounds;\nhair,\n; eyes,\ncolor of blue\n;\nother visible distinctive marks:\nnone\nI was\nborn in Chubenice austria; now Poland.\non the 13 & day of\nOctober\n(Country)\nGiswold\n1 1888\nMy present residence is aleaventh (Number and City street) Com (City town) Newlondon, (County) 1182 (State)\nor\nMy\nThe place where I tock the ship or train which landed me in the United States was Hamblrg\npost office address is BX 1182, 9 City\ngawett\n, on March,\n12\n19.10\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\nThe name of the ship or railroad on which I came was Everydent (City) grand. (Country)\n(OVER) President Grant"
}