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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5103
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 (first paper) to become a citizen.
Déclaration saul of Intention Gersheugoren
Mr.
My name is
Mrs.
Sant (Alien should Bershangone here
; age,
21
years.
Miss
print or typewrite tige, original, and correct name)
(Give age last birthday)
My present occupation is
authorizing college student
My personal description is: Color, white ; complexion, dark ; height, 5 feet 2 1/2 inches;
weight, 120 pounds; color of hair, darkbrown color of eyes, brown
;
I was born in
other visible distinctive marks: aussid
Kier
(City or town)
(Country)
on the 23
day of
aper
, 1906
My present residence is
46 jay
new London
Cfnn.
(Number and street)
(Óity or town)
(County)
(State)
The place where I took the ship or train which landed me in the United States was
Licbow
Russia
,on
(Month)
(Day)
,
(Year)
The name of the ship or railroad on which I came was
Koorsch
My last place of foreign residence was
I araschtela,
Russia
(City or town)
(Country)
I am not married. The name of my { wife
}
She
is
He
}
was born at
husband
, and now resides at
I am
now a subject of and intend to renounce allegiance to (Write name and title of sovereign and country of which now a
subject;
or, if citizen of a republic, write name of republic only)
NI
arrived at the United States immigration port of
new york
(City or town)
new York
,
on fune 10,1915
(State or territory)
14-8
(Give exact month, day, and year)
(OVER)
Page data
- Page
- 458
- Source index
- 0
- Type
- photo
- Media ID
- 6b3dac69adce82e6
- 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\n5103\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 (first paper) to become a citizen.\nDéclaration saul of Intention Gersheugoren\nMr.\nMy name is\nMrs.\nSant (Alien should Bershangone here\n; age,\n21\nyears.\nMiss\nprint or typewrite tige, original, and correct name)\n(Give age last birthday)\nMy present occupation is\nauthorizing college student\nMy personal description is: Color, white ; complexion, dark ; height, 5 feet 2 1/2 inches;\nweight, 120 pounds; color of hair, darkbrown color of eyes, brown\n;\nI was born in\nother visible distinctive marks: aussid\nKier\n(City or town)\n(Country)\non the 23\nday of\naper\n, 1906\nMy present residence is\n46 jay\nnew London\nCfnn.\n(Number and street)\n(Óity or town)\n(County)\n(State)\nThe place where I took the ship or train which landed me in the United States was\nLicbow\nRussia\n,on\n(Month)\n(Day)\n,\n(Year)\nThe name of the ship or railroad on which I came was\nKoorsch\nMy last place of foreign residence was\nI araschtela,\nRussia\n(City or town)\n(Country)\nI am not married. The name of my { wife\n}\nShe\nis\nHe\n}\nwas born at\nhusband\n, and now resides at\nI am\nnow a subject of and intend to renounce allegiance to (Write name and title of sovereign and country of which now a\nsubject;\nor, if citizen of a republic, write name of republic only)\nNI\narrived at the United States immigration port of\nnew york\n(City or town)\nnew York\n,\non fune 10,1915\n(State or territory)\n14-8\n(Give exact month, day, and year)\n(OVER)"
}