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{
    "localId": "159596813",
    "label": "File numbers 4874 - 5509, 1926-1930",
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    "contentType": "document",
    "title": "File numbers 4874 - 5509, 1926-1930",
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        "Naturalization Records of Non-Federal Courts in Connecticut",
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{
    "seq": 133,
    "pageIndex": 0,
    "type": "photo",
    "url": "https://s3.amazonaws.com/NARAprodstorage/lz/partnerships-0002/18-0177_US-MA/18-0177_US-MA_21/18-0177_US-MA_-4526886-CTN-Applications-for-Declaration-of--1926-1930/18-0177_US-MA_-4526886-CTN-Applications-for-Declaration-of--1926-1930_00133.jpg",
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    "ocrText": "7574 II\nForm 2213\n6-30\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4941\nU. S. DEPARTMENT OF LABOR\nNOT TO BE FILLED IN BY ALIEN\nFOR USE OF OFFICIALS SEARCHING IMMI-\nNATURALIZATION SERVICE\nGRATION RECORDS\nHATURALIZAZTON SERVICE\nCLERK OF COURT:\nRECEIVED\nRECORDS EXAMINED\nPlace number 27738 in\nCARD INDEX\nDEC 13 1926\nupper left-hand corner of all copies of\ndeclaration, immediately under your\nINDEX BOOKS\ndeclaration number.\nis\nas us\nBOB 14 10/200 to\nDISTRICT DIRECTOR OF NATURALIZATION\nMANIFESTS\n00\nloty\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 citizon\nV. Diepen anna\nMr.\nMy name is\nMrs.\nthis Annah ofan Diepen\n; age,\n49\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nAlso known as\nfrom Peter Van Dispen\n(If alien has used any other name in this country, that name should be shown here)\nI used that name because\nHusband same\nThe\nfull\nname\nof the person shown on my steamship ticket was Fran Piter fan Disperp\nMy mother's maiden name was Kathrine stills\nMy\nmaiden name was (if woman) Anna Hermanns\nMy present\nocccupation is House nife 6-14-231\nMy personal description is: Color, White ; complexion, fair ; height, 5 feet 4 5 inches;\nweight, 225 pounds; color of hair, buy\n; color of eyes, have Brown\n;\nother visible distinctive marks:\nthurtay\nI was born in brehrath\nor\nBermany\n(Country) palm\non the 26thy day of ganuary (City town)\n1877\nMy present residence is 31 Seensmine , Ave\n(Number and street)\n(City or town)\n(County)\n(State)\nMy post office address is Myster\nWew London Cohn\nThe place where the ship or train which landed me in the United States was\nI took Bremen\nGermany\n, on June (Month) 2 nd (Day) 1923 (Year)\nThe\nticket on which I camo to this country was bought at\nThe name of the ship or railroad on which I came was (OVER) S.C. befdling\nlenefield (City) permany (Country)\n014-8"
}