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Form 2213
30.2 - 694
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5232
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
NATURALIZATION SERVICE
40260
MANIFESTS
they
Place number
in
RECHIVAD
CARD INDEX
upper left-hand corner of all copies of
declaration, immediately under your
INDEX BOOKS
that
NOV 17 1927
declaration number.
OFFICE OF EXAMINER
DISTRICT DIRECTOR OF NATURALIZATION
NEW HAVEN, CONN.
us
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
!
Irving Heller
; age,
22
years.
Miss
Ilien should print or typewrite here true, original, and correct name)
(Give age last birthday)
My present occupation is
carpenter
My personal description is: Color, white complexion, mediseum ; height, 5 feet
fair
5
inches;
weight, 159
pounds; color of hair,
dark
broun
; color of eyes,
other visible distinctive marks: Scarson backofrick
Blue any gray;
I was born
in Poland Kleck, Russia, mow Poland
(City or town)
(Country)
on the 23
day of Oct.
1905
My
present residence is 14 19 sharley st newsondon (County) (State)
(Number and street)
(City or town)
The place where I took
the ship or train which landed me in the United States was antwerp
Belgium
,on
7 1921
(Month)
(Day)
(Year)
The name of the ship or railroad on which/I came was godland
My last place of foreign residence was
saidneen
Russian
(City or town)
(Country)
wife
She
I am not married. The name of my
is
All subject 9.920 of
husband
He
}
was born at
, and now resides at
,
I
am now a and intend to renounce allegiance to
(Write and title of sovereign and of which
NOV
name country now subject;
or, if citizen of a republic, write name of republic only)
I United States immigration port of
newyork
(City or town)
ny.
, on
be nov. 1921
(State or territory)
14-8
(Give exact month, day, and year)
Seller Icko
(OVER)
Page data
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- Type
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- Size
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Document data
- ID
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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\n30.2 - 694\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5232\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\nNATURALIZATION SERVICE\n40260\nMANIFESTS\nthey\nPlace number\nin\nRECHIVAD\nCARD INDEX\nupper left-hand corner of all copies of\ndeclaration, immediately under your\nINDEX BOOKS\nthat\nNOV 17 1927\ndeclaration number.\nOFFICE OF EXAMINER\nDISTRICT DIRECTOR OF NATURALIZATION\nNEW HAVEN, CONN.\nus\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\n!\nIrving Heller\n; age,\n22\nyears.\nMiss\nIlien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nMy present occupation is\ncarpenter\nMy personal description is: Color, white complexion, mediseum ; height, 5 feet\nfair\n5\ninches;\nweight, 159\npounds; color of hair,\ndark\nbroun\n; color of eyes,\nother visible distinctive marks: Scarson backofrick\nBlue any gray;\nI was born\nin Poland Kleck, Russia, mow Poland\n(City or town)\n(Country)\non the 23\nday of Oct.\n1905\nMy\npresent residence is 14 19 sharley st newsondon (County) (State)\n(Number and street)\n(City or town)\nThe place where I took\nthe ship or train which landed me in the United States was antwerp\nBelgium\n,on\n7 1921\n(Month)\n(Day)\n(Year)\nThe name of the ship or railroad on which/I came was godland\nMy last place of foreign residence was\nsaidneen\nRussian\n(City or town)\n(Country)\nwife\nShe\nI am not married. The name of my\nis\nAll subject 9.920 of\nhusband\nHe\n}\nwas born at\n, and now resides at\n,\nI\nam now a and intend to renounce allegiance to\n(Write and title of sovereign and of which\nNOV\nname country now subject;\nor, if citizen of a republic, write name of republic only)\nI United States immigration port of\nnewyork\n(City or town)\nny.\n, on\nbe nov. 1921\n(State or territory)\n14-8\n(Give exact month, day, and year)\nSeller Icko\n(OVER)"
}