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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5086
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
upper left-hand corner of all copies of
CARD INDEX
declaration, immediately under your
INDEX BOOKS
declaration number.
DISTRICT DIRECTOR OF NATURALIZATION
MANIFESTS
Semen Pashkiwich
I desire to file my Declaration of Intention (first paper) to become a citizen.
32
Mr.
My name is
Mrs.
}
Sam Pullicial
; age, 33
years.
Miss
(Alien should print or typewrite here true, original, and correct name)
(Give age last birthday)
My present occupation is
g B martin Can veloctwearts
My personal description is: Color, White complexion, light
dark 3-
;
height, X feet 8/4 inches;
weight, 150 pounds; color of hair, black darkfrown ; color of eyes, browngray
I
was born in Willno Vilna, inssignan-Poland
other visible distinctive marks: forefinger
(City or town)
(Country)
on
the of
September
, 1894
My
present
residence is 5 Sixth new London Com.
norwich
(Number and street)
(City or town)
(County)
a
(State)
The place where I took the ship train which landed in the United States Handing
or me was
Germany
, on
February (Month) (Day) 18 (Year) 1963
The of the ship railroad which I
name or on came was
My last place of foreign residence was
(City or town)
(Country)
wife
I am
is Sphie
She
married. The name of my
husband
}
was born at
He
Willngsaid Vilua
, and now resides at said 5-S ithstrut
I am now a subject of and intend to renounce allegiance to
Paland
(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 (City town) City,
york
or
new (State or york territory)
, on
march 15, 1913
/14-8
(Give exact month, day, and year)
(OVER)
Page data
- Page
- 424
- Source index
- 0
- Type
- photo
- Media ID
- 6c68ae1d203bc056
- 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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Document source extras
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Page context
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5086\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\nupper left-hand corner of all copies of\nCARD INDEX\ndeclaration, immediately under your\nINDEX BOOKS\ndeclaration number.\nDISTRICT DIRECTOR OF NATURALIZATION\nMANIFESTS\nSemen Pashkiwich\nI desire to file my Declaration of Intention (first paper) to become a citizen.\n32\nMr.\nMy name is\nMrs.\n}\nSam Pullicial\n; age, 33\nyears.\nMiss\n(Alien should print or typewrite here true, original, and correct name)\n(Give age last birthday)\nMy present occupation is\ng B martin Can veloctwearts\nMy personal description is: Color, White complexion, light\ndark 3-\n;\nheight, X feet 8/4 inches;\nweight, 150 pounds; color of hair, black darkfrown ; color of eyes, browngray\nI\nwas born in Willno Vilna, inssignan-Poland\nother visible distinctive marks: forefinger\n(City or town)\n(Country)\non\nthe of\nSeptember\n, 1894\nMy\npresent\nresidence is 5 Sixth new London Com.\nnorwich\n(Number and street)\n(City or town)\n(County)\na\n(State)\nThe place where I took the ship train which landed in the United States Handing\nor me was\nGermany\n, on\nFebruary (Month) (Day) 18 (Year) 1963\nThe of the ship railroad which I\nname or on came was\nMy last place of foreign residence was\n(City or town)\n(Country)\nwife\nI am\nis Sphie\nShe\nmarried. The name of my\nhusband\n}\nwas born at\nHe\nWillngsaid Vilua\n, and now resides at said 5-S ithstrut\nI am now a subject of and intend to renounce allegiance to\nPaland\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 (City town) City,\nyork\nor\nnew (State or york territory)\n, on\nmarch 15, 1913\n/14-8\n(Give exact month, day, and year)\n(OVER)"
}