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    "localId": "159596813",
    "label": "File numbers 4874 - 5509, 1926-1930",
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    "contentType": "document",
    "title": "File numbers 4874 - 5509, 1926-1930",
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        "Naturalization Records of Non-Federal Courts in Connecticut",
        "Applications for Declaration of Intention"
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    "seq": 663,
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    "ocrText": "5206\na\nForm 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\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.\nHypolit (Alien should print typewrite Kubiak here true, original, and\n; age,\n34\nyears.\nMiss\nor correct name)\n(Give age last birthday)\nMy present occupation is\nLabour\nMy personal weight, 215 description pounds; is: Color, color white of hair, trufair ; complexion, ; color of eyes, ; height, bagel 5 feet\n94/2 inches;\n;\nI\nwas born in Famulhi- Lazeurbe Russia, Poland\nother visible distinctive marks: Scars , on left forefinged\n(City or towny\n(Country)\non the 20\nday of\nSeptember\n1893\nMy present residence is 4 Gillmore norwich new London, Comm.\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 was Bremen Germany\nS.S. on april (Month)\n28th\n1912\nThe name of the ship or railroad on which I came was (Day) Poland (Year)\nMy last place of foreign was\nresidence said Famulki- Lazewske Poland\n(City or town)\n(Country)\nwife\nI am\nmarried. The name of my\n}\nis : anna\nShe\nwas born at\nhusband\n, and now\nsaid resides at 4 Gillmonts norwith Ct\nHe\nPoland\nI am now a to renounce\nsubject of and intend allegiance to the Republic of Poland\nWrite name and title of sovereign and country of which now a subject;\nor, if citizen of a republic, write name of republic\nI\narrived at the United States immigration only) port of new york\n(City or town)\nnew\nyork\n, on may 1th, 1912\n(State or territory)\n14-t8\n(Give exact month, day, and year)\n(OVER)"
}