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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5111
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.
Miss
Antoni (Alien should print typewrite Ziniewic here true, original, and correct
; age,
19
years.
or name)
(Give age last birthday)
My present occupation is
Paper mill Hand.
My personal description is: Color, white ; complexion, light
; height, 5 feet 63/4 inches;
weight, 130 pounds; color of hair, light
;
color of eyes, brown
;
I was other born visible in distinctive marks:
on the 27
day of
(City or town) november austria (Country) countrious Paland
,
1907
My present residence is
R.K.S.HI
(Number and street)
(County) (State) Conn
Spragne
(City or town)
The place where I took the ship or train which landed me in the United States was
, on August
15
1912
(Month)
(Day)
(Year)
The name of the ship or railroad on which I came was
Pyrtem
I am not married. The name of my {
My last place, of foreign residence was Roland (City or town) said Brajows (Country)
wife
}
She
is
husband
was born at
He
,and now resides at
,
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 your (City or town) sext 1912
, on
(State or territory)
14-8
(Give exact month, day, and year)
(OVER)
Page data
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- Source index
- 0
- Type
- photo
- Media ID
- 1128236b2d5fba9c
- Size
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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\n5111\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.\nMiss\nAntoni (Alien should print typewrite Ziniewic here true, original, and correct\n; age,\n19\nyears.\nor name)\n(Give age last birthday)\nMy present occupation is\nPaper mill Hand.\nMy personal description is: Color, white ; complexion, light\n; height, 5 feet 63/4 inches;\nweight, 130 pounds; color of hair, light\n;\ncolor of eyes, brown\n;\nI was other born visible in distinctive marks:\non the 27\nday of\n(City or town) november austria (Country) countrious Paland\n,\n1907\nMy present residence is\nR.K.S.HI\n(Number and street)\n(County) (State) Conn\nSpragne\n(City or town)\nThe place where I took the ship or train which landed me in the United States was\n, on August\n15\n1912\n(Month)\n(Day)\n(Year)\nThe name of the ship or railroad on which I came was\nPyrtem\nI am not married. The name of my {\nMy last place, of foreign residence was Roland (City or town) said Brajows (Country)\nwife\n}\nShe\nis\nhusband\nwas born at\nHe\n,and now resides at\n,\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 your (City or town) sext 1912\n, on\n(State or territory)\n14-8\n(Give exact month, day, and year)\n(OVER)"
}