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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5091
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
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
My name is
Mrs.
anna (Alien should print or typewrite narbening here true, original, and correct name)
; age,
29
years.
Miss
(Give age last birthday)
My present occupation is
Farmer
My personal description is: Color, white trafact ; complexion,
houscwrit
; height, 5 feet 4/12 inches;
weight, 138 pounds; color of hair, ;
other visible distinctive marks: none
color of eyes, gray
;
I was born in
on the 21st
Koropatniky
Austria
(City or town)
(Country)
day of
September
1
897
My present residence is
Colchester newdondow Come.
(Number and street)
(City or town)
(County)
(State)
The place where I took the ship or train which landed me in the United States
april was Hamburg
Germany
, on Either healthand (Month) (Day) (Year) 1906
The name of the ship or railroad on which I came was
Kaiserin-Victoria
My last
place of foreign residence was (City town) Austria (Country)
Moropating
or
wife
,
}
She
I am married. The name of my
sing Kuisali +
is
He
}
was born at
husband
A
, and
now resides at , Comm.
I am now a subject of and intend to renounce allegiance to
Kussia
(Write name and title of sovereign and country of which now a subject;
or, if citizen of a
repúblic, the Republicy write name of republic only) Poland
I arrived at the United States immigration port of
new (City
York
or town)
new (State or territory)
York
, on
(OVER)
may 14-8 (Give exact month, day, 6, and year)
1906
Page data
- Page
- 434
- Source index
- 0
- Type
- photo
- Media ID
- 235458c58050c9a4
- 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\n5091\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\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nMy name is\nMrs.\nanna (Alien should print or typewrite narbening here true, original, and correct name)\n; age,\n29\nyears.\nMiss\n(Give age last birthday)\nMy present occupation is\nFarmer\nMy personal description is: Color, white trafact ; complexion,\nhouscwrit\n; height, 5 feet 4/12 inches;\nweight, 138 pounds; color of hair, ;\nother visible distinctive marks: none\ncolor of eyes, gray\n;\nI was born in\non the 21st\nKoropatniky\nAustria\n(City or town)\n(Country)\nday of\nSeptember\n1\n897\nMy present residence is\nColchester newdondow Come.\n(Number and street)\n(City or town)\n(County)\n(State)\nThe place where I took the ship or train which landed me in the United States\napril was Hamburg\nGermany\n, on Either healthand (Month) (Day) (Year) 1906\nThe name of the ship or railroad on which I came was\nKaiserin-Victoria\nMy last\nplace of foreign residence was (City town) Austria (Country)\nMoropating\nor\nwife\n,\n}\nShe\nI am married. The name of my\nsing Kuisali +\nis\nHe\n}\nwas born at\nhusband\nA\n, and\nnow resides at , Comm.\nI am now a subject of and intend to renounce allegiance to\nKussia\n(Write name and title of sovereign and country of which now a subject;\nor, if citizen of a\nrepúblic, the Republicy write name of republic only) Poland\nI arrived at the United States immigration port of\nnew (City\nYork\nor town)\nnew (State or territory)\nYork\n, on\n(OVER)\nmay 14-8 (Give exact month, day, 6, and year)\n1906"
}