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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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    "collections": [
        "Naturalization Records of Non-Federal Courts in Connecticut",
        "Applications for Declaration of Intention"
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    "seq": 748,
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    "ocrText": "52489 District Director of naturalization\nForm 2213\nP.O Bedg\nFACTS FOR DECLARATION OF INTENTION Boston mass.\nClark al Osart. 19963\nPlease\nor\nsk\nof\nU. S. DEPARTMENT OF LABOR\nnumber\nNATURALIZATION SERVICE\nDistriot er\nMan\nNOTE.-A copy of this form will be furnished by the clerk of the court, the Chief Naturalization Examiner, or the\npublic-school teacher to each applicant for a declaration of intention, so that he can at his leisure fill in the answers to\nthe questions. After being filled out the applicant should tako the form to the office of the clerk of court to be used\nby him in properly filling out the declaration. Caro should be used to state as near as can be remembered the day,\nmonth, and year of arrival, as well as the name of the vessel on which the alien emigrated to this country.\nTO THE APPLICANT.-The fee of one dollar required by law for the declaration, must be paid to the clerk of the\ncourt before he commences to fill out the declaration of intention. No fee is chargeable for this blank, and none\nshould be paid for assistance Naturalization Examiner or the public-school teacher will help you\nfree of charge.\nSinclais\nin filling D.J. it out, as Jackut the\n23\nMy name is Kenneth\nAge: 73 years.\n(Alien should state here his true, original, and correct name in full.)\n(Give age at last birthday.)\nAlso known as\n(If alien has used any other name in this country, that name should be shown on line immediately above.),\nOccupation:\nbled\nColor: white\nComplexion:\ncalifornition\n5\nHeight:\nfeet\ninches. Weight:\n130 pounds.\nColor of hair: to Boreva\nColor of eyes: Brown\nBURBAU OF\nOther marks:\nvisible distinctive\nWhere\nborn: pauheo , (If no visible distinctive marks, so state,)\n(City or town.)\n(Country.)\nDate of birth: march\n,\n1st (Day, rich 1904 (Year.)\nPresent 156 Laurel residence: (Month.) (Number and street.) mca, (City north or town.) readers (State, mass Territory, or\nGlasgraw\nScotland\nDistrict.)\nEmigrated from:\n(Place where alien got on ship or train to come to the United States.) +\n(Country.)\nName of vessel:\nCamerona\nRhuros Canthets (Irtheaticn\narrived otherwise than by vessel, the character of conveyance or name of transportation comparry should be given.)\nsereland\nLast place off foreign restuence:\n,\n(City or town.)\n(Country.)\n*I am neith married; the name of my thusband (wife is\n(she)\n;\nthe } was\n*born at\n; and now resides at\nI\nam now a subject of and intend to renounce allegiance to Gurgat\nEuproor V, King of Great Britain and Ireland.\n(Write name and title of sbyereign and country of which now a subject; or if citizen of a Republic, write name of Republiconly.)\nI arrived at the port of\nnewelon\n,\nmy\n(City ortown.\n(State or Territory.)\non or about August (Month.)\n984\n1925\n,\n,\n(Day.)\n(Year.)\n* NOTE TO CLERK OF COURT. -The two lines indicated by the * contain information which is provided for by blanks on the latest\ndeclaration of intention form; until such time as you may be supplied with forms containing these blank spaces the information called\nfor herein should be inserted immediately ABOVE the twelfth line, which begins It is my bona fide intention,\" etc., as requested in\ncircular letter of January 5, 1916.\ninmind\nMAY 29 1926"
}