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File numbers 4874 - 5509, 1926-1930

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Form 2213 PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN 4952 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. Prokop (Alien should print typewrite here true, original, name) ; age, 51 years. Miss or and correct (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 My maiden name was (if woman) My personal description is: Color, white ; complexion, fair ; height, 5 feet 61/2 inches; My present occcupation is farmer weight, 160 pounds; color of hair, darkbown ; color of eyes, blue ; other visible distinctive marks: I was born in Galicia, now Poland Mikolajow, none (City town) on the 1st day (Country) of June 1875 My present residence is coun. (Numbertand street) (City or town) (State) My post office address is no. 2, Colchester (County) R.J.D. The place where I took the train Rollert ship or which landed me in the United States was Italy , on (Month) (Day) (Year) The ticket on which I came to this country was bought at The name of or on came the ship railroad which I was (OVER) Contract (City) know) Country) 014-8

Page data

Page
155
Source index
0
Type
photo
Media ID
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Size
unknown

Document data

ID
159596813
Core
doc
Type
document
DTO data 
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Context sent to Scholar

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    "ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4952\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.\nProkop (Alien should print typewrite here true, original, name) ;\nage,\n51\nyears.\nMiss\nor and correct\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\nMy maiden name was (if woman)\nMy personal description is: Color, white ; complexion, fair ; height, 5 feet 61/2 inches;\nMy present occcupation is farmer\nweight, 160 pounds; color of hair, darkbown ; color of eyes, blue\n;\nother visible distinctive marks:\nI was born\nin Galicia, now Poland\nMikolajow,\nnone\n(City town)\non the\n1st day\n(Country)\nof\nJune\n1875\nMy present residence is\ncoun.\n(Numbertand street)\n(City or town)\n(State)\nMy post office address\nis no. 2, Colchester (County)\nR.J.D.\nThe place where I took the train Rollert\nship or which landed me in the United States was\nItaly\n, on\n(Month)\n(Day)\n(Year)\nThe ticket on which I came to this country was bought at\nThe name of or on came\nthe ship railroad which I was (OVER) Contract (City) know) Country)\n014-8"
}