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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5029
U. S. DEPARTMENT OF LABOR
NOT TO BE FILLED IN BY ALIEN
FOR USE OF OFFICIALS SEARCHING IMMI-
NATURALIZATION SERVICE
GRATION RECORDS
NATURAEIZATION SERVICE
CLERK OF COURT:
RECEIVED
RECORDS EXAMINED
Place number
29627
in
CARD INDEX
JAN 18 1927
upper left-hand corner of all copies of
declaration, immediately under your
INDEX BOOKS
declaration number.
OFFICE TO OF EXAMINER
TAVEN, CONN.
us LABUR
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.
Chaim Rogowy
; age,
33
years.
Miss
(Alien should print or hero-true, original, and correct name)
(Give age last birthday)
Also known as
Chaim Robovin
(If alien has sed any other name in this country, that name should be, shown here)
I used that name because Simpler Pronunciation
HAR 1g 7927 BC
The full name of the person shown on my steamship ticket was Chaim Rogowy
My mother's maiden name was Chaya
My maiden name was (if woman)
My personal description is: Color, White complexion, White ; height, 5 feet Kg inches;
My present occcupation is Apricultunes farmersiar
weight, 135 pounds; color of hair, Drown
Black
; color of eyes,
dark Brown
;
other visible distinctive marks: inface
I was born in Wolozyno Russia, now Poland
(City or town)
(Country)
on the 27th day of May
, 1893
My present residence is P.O.B. 342 in Connecticut
and
(City or town)
(County)
(State)
My post office address is P.O.B. 342 Niantic Conn. %.1.Wilensky
The
place where I took the ship or train which landed me in the United States was Seuthhampton
Endand
, on December 7 1926
(Month)
(Day)
(Year)
The
ticket on s which I came to this country was bought at Warsaw Poland
(City)
(Country)
The name or on came was
of the ship railroad which I Berengaria
(OVER)
o14--8
O/A ISSUED
JAN 31 1927
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Document data
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5029\nU. S. DEPARTMENT OF LABOR\nNOT TO BE FILLED IN BY ALIEN\nFOR USE OF OFFICIALS SEARCHING IMMI-\nNATURALIZATION SERVICE\nGRATION RECORDS\nNATURAEIZATION SERVICE\nCLERK OF COURT:\nRECEIVED\nRECORDS EXAMINED\nPlace number\n29627\nin\nCARD INDEX\nJAN 18 1927\nupper left-hand corner of all copies of\ndeclaration, immediately under your\nINDEX BOOKS\ndeclaration number.\nOFFICE TO OF EXAMINER\nTAVEN, CONN.\nus LABUR\nDISTRICT DIRECTOR OF NATURALIZATION.\nMANIFESTS\n(NOTE\nTO\nCLERK\nOF\nCOURT.-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.\nChaim Rogowy\n; age,\n33\nyears.\nMiss\n(Alien should print or hero-true, original, and correct name)\n(Give age last birthday)\nAlso known as\nChaim Robovin\n(If alien has sed any other name in this country, that name should be, shown here)\nI used that name because Simpler Pronunciation\nHAR 1g 7927 BC\nThe full name of the person shown on my steamship ticket was Chaim Rogowy\nMy mother's maiden name was Chaya\nMy maiden name was (if woman)\nMy personal description is: Color, White complexion, White ; height, 5 feet Kg inches;\nMy present occcupation is Apricultunes farmersiar\nweight, 135 pounds; color of hair, Drown\nBlack\n; color of eyes,\ndark Brown\n;\nother visible distinctive marks: inface\nI was born in Wolozyno Russia, now Poland\n(City or town)\n(Country)\non the 27th day of May\n, 1893\nMy present residence is P.O.B. 342 in Connecticut\nand\n(City or town)\n(County)\n(State)\nMy post office address is P.O.B. 342 Niantic Conn. %.1.Wilensky\nThe\nplace where I took the ship or train which landed me in the United States was Seuthhampton\nEndand\n, on December 7 1926\n(Month)\n(Day)\n(Year)\nThe\nticket on s which I came to this country was bought at Warsaw Poland\n(City)\n(Country)\nThe name or on came was\nof the ship railroad which I Berengaria\n(OVER)\no14--8\nO/A ISSUED\nJAN 31 1927"
}