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Form 2213
St John
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4936
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 24195 in
number
CARD INDEX URALIZATION
SHRVIOW
upper left-hand corner of all copies of
JUL 11 1926
declaration, immediately under your
INDEX BOOKS
declaration number.
JUL 13.1926
OFFICE of EXAMINER
DISTRIOT DIRECTOR
NKW HAVEN, CONN.
DISTRICT DIRECTOR OF NATURALIZATION.
MANIFESTS
MASS.
DEPARTMENT ur' LABUK
of LABOR.
(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.
Benjamin (Alien Gredsteen
; age,
27
years.
Miss
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
My mother's maiden name was
Lena Bloom
My maiden name was (if woman) -
My present occcupation is
Farmer
My personal description is: Color, White ; complexion, Dank
fair
Y2
height,
5 feet 5 inches;
weight,
127 pounds; color of hair, Black dark. ; brown Brown
color of eyes,
;
other visible distinctive marks: - none
I was in
born Parsbaro
nova Scatea
(City or town)
(Country)
on the
9th
day of
may
1899
My present residence is
Pachang
(Number and
street) John Grighold, Come (State)
My post office address is
Pachany
bonn (City or town) Griends (County)
The place where I took the ship or train which landed me was
in the United States
nova Scotia banada
, on sept
Jangara
22 1972
(Month)
(Day)
(Year)
The ticket on which I came to this country was bought at
C.PAR (City) Canadian (Country)
Jaggin
n. S.
The name of the ship or railroad on which I came was
(OVER) Pacific Railway c14-8
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Document data
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"ocrText": "-\nForm 2213\nSt John\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4936\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 24195 in\nnumber\nCARD INDEX URALIZATION\nSHRVIOW\nupper left-hand corner of all copies of\nJUL 11 1926\ndeclaration, immediately under your\nINDEX BOOKS\ndeclaration number.\nJUL 13.1926\nOFFICE of EXAMINER\nDISTRIOT DIRECTOR\nNKW HAVEN, CONN.\nDISTRICT DIRECTOR OF NATURALIZATION.\nMANIFESTS\nMASS.\nDEPARTMENT ur' LABUK\nof LABOR.\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.\nBenjamin (Alien Gredsteen\n; age,\n27\nyears.\nMiss\nshould 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\nMy mother's maiden name was\nLena Bloom\nMy maiden name was (if woman) -\nMy present occcupation is\nFarmer\nMy personal description is: Color, White ; complexion, Dank\nfair\nY2\nheight,\n5 feet 5 inches;\nweight,\n127 pounds; color of hair, Black dark. ; brown Brown\ncolor of eyes,\n;\nother visible distinctive marks: - none\nI was in\nborn Parsbaro\nnova Scatea\n(City or town)\n(Country)\non the\n9th\nday of\nmay\n1899\nMy present residence is\nPachang\n(Number and\nstreet) John Grighold, Come (State)\nMy post office address is\nPachany\nbonn (City or town) Griends (County)\nThe place where I took the ship or train which landed me was\nin the United States\nnova Scotia banada\n, on sept\nJangara\n22 1972\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\nC.PAR (City) Canadian (Country)\nJaggin\nn. S.\nThe name of the ship or railroad on which I came was\n(OVER) Pacific Railway c14-8"
}