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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5370
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
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
Mrs. Anna Zawislinski
; age,
39
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
My
My personal description is: Color, white complexion, fair
present occupation is Housekoover wife
; height, 5 feet 13/4 inches;
weight, 135 pounds; color of hair, brown
;
color of eyes, hagel
;
onright other visible middle distinctive marks: now Poland and scar
I was born in
dalefinger
Austria,
(City or town)
(Country)
on the 29th
day of
June
, 1 889,
My present residence is
4 North st.,
Norwich,
New London, conn.
(Number and street)
(City or town)
(County)
(State)
The place where I took the ship or train which landed me in the United States was Hamburg. Germany
, on oct.
4th,
1904
The of the ship railroad which I 1 (Month) )
(Day)
(Year)
name or on came was
not remember
said
My last place of foreign residence was
Pewell-Wielka,
Austria Poland
A
(City or town)
(Country)
wife
I am
Jan
She
married. The name of my
is
was born at
5
husband
Rusian)POland
said
He
, and now resides at 4 North St., Hormion gonn
,
X
I am now a subject of and intend to renounce allegiance to
the Ribublic of Poland
(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)
New Yotk
, on
oct. 17th, 1904
(State or territory)
14-8
(Give exact month, day, and year)
(OVER)
Page data
- Page
- 991
- Source index
- 0
- Type
- photo
- Media ID
- f66260cf9dd93009
- 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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Document source metadata
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Page context
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5370\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\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nMrs. Anna Zawislinski\n; age,\n39\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nMy\nMy personal description is: Color, white complexion, fair\npresent occupation is Housekoover wife\n; height, 5 feet 13/4 inches;\nweight, 135 pounds; color of hair, brown\n;\ncolor of eyes, hagel\n;\nonright other visible middle distinctive marks: now Poland and scar\nI was born in\ndalefinger\nAustria,\n(City or town)\n(Country)\non the 29th\nday of\nJune\n, 1 889,\nMy present residence is\n4 North st.,\nNorwich,\nNew London, conn.\n(Number and street)\n(City or town)\n(County)\n(State)\nThe place where I took the ship or train which landed me in the United States was Hamburg. Germany\n, on oct.\n4th,\n1904\nThe of the ship railroad which I 1 (Month) )\n(Day)\n(Year)\nname or on came was\nnot remember\nsaid\nMy last place of foreign residence was\nPewell-Wielka,\nAustria Poland\nA\n(City or town)\n(Country)\nwife\nI am\nJan\nShe\nmarried. The name of my\nis\nwas born at\n5\nhusband\nRusian)POland\nsaid\nHe\n, and now resides at 4 North St., Hormion gonn\n,\nX\nI am now a subject of and intend to renounce allegiance to\nthe Ribublic of Poland\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,\n(City or town)\nNew Yotk\n, on\noct. 17th, 1904\n(State or territory)\n14-8\n(Give exact month, day, and year)\n(OVER)"
}