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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
4912
U. S. DEPARTMENT OF LABOR
NOT TO BE FILLED IN BY ALIEN
FOR USE OF OFFICIALS SEARCHING IMMI-
NATURALIZATION SERVICE
GRATION RECORDS
SERVICE
CLERK OF COURT:
RECORDS EXAMINED
RECEAVED
Place
number 245,89 In
CARD INDEX
upper left-hand corner of all copies of
SEP 9 1926
declaration, immediately under your
INDEX BOOKS
declaration number.
OFFICE of EXAMINER
NEW HAVEN, CONN.
DEPARTMENT OF LABOR
DISTRICT DIRECTOR OF NATURALIZATION.
MANIFESTS
(NOTE TO CLERK OF COURT.-To guide you in preparing the Declaration: The black face lines on this form contain
statements
in the regular order as they are to appear on the Declaration of Intention.)
I desire to file my Declaration of Intention (first paper) to become a citizen.
Mr.
Hermann Michae Lis
Hugh
My name ise
; age,
34
years.
(Alien should print/on typewrite here true, original, and correct name)
(Give age last birthday)
Also known as
na
(If alien has used any other name in this country, that name should be shown here)
I used that name because no
The full name of the person shown on my steamship ticket was Herman Michaeline
My mother's maiden name was Rosine Bach
NATURALIZATICE
RECEIVED
My maiden name was (if woman)
the
P
SEP 10 19281
Baker
K
My present occcupation is
My personal description is: Color, white ; complexion, lightfur ; height, 5 feet
ACKND 53/4
of inches;
weight, 156 pounds; color of hair,
lightbroud
A
; eyes,
color of blue
;
other visible
distinctive marks: the Scar on lift - scarce
I was born in
Hamburg
Germany
Free start
(CityCor town)
(Country)
on
the 20 day
of
August
1 892
,
My present residence is 141 (Number and street) It, (City or norroich, town) now (County) London, (State) Cam
Brounley
My office is Bry 73 73
post address
The place where I took the ship or train which landed me in the United States was Bremen
Germany
on Obdober
10. 1924
,
(Month)
(Day)
(Year)
The this bought at Breamen Free Start
ticket on which I came to country was
muncher
(City)
(Country)
The name of the ship or railroad on which I came was
(OVER) muenchen
C/A leened c14-8
NOV 10 1926
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Document data
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n4912\nU. S. DEPARTMENT OF LABOR\nNOT TO BE FILLED IN BY ALIEN\nFOR USE OF OFFICIALS SEARCHING IMMI-\nNATURALIZATION SERVICE\nGRATION RECORDS\nSERVICE\nCLERK OF COURT:\nRECORDS EXAMINED\nRECEAVED\nPlace\nnumber 245,89 In\nCARD INDEX\nupper left-hand corner of all copies of\nSEP 9 1926\ndeclaration, immediately under your\nINDEX BOOKS\ndeclaration number.\nOFFICE of EXAMINER\nNEW HAVEN, CONN.\nDEPARTMENT OF LABOR\nDISTRICT DIRECTOR OF NATURALIZATION.\nMANIFESTS\n(NOTE TO CLERK OF COURT.-To guide you in preparing the Declaration: The black face lines on this form contain\nstatements\nin the regular order as they are to appear on the Declaration of Intention.)\nI desire to file my Declaration of Intention (first paper) to become a citizen.\nMr.\nHermann Michae Lis\nHugh\nMy name ise\n; age,\n34\nyears.\n(Alien should print/on typewrite here true, original, and correct name)\n(Give age last birthday)\nAlso known as\nna\n(If alien has used any other name in this country, that name should be shown here)\nI used that name because no\nThe full name of the person shown on my steamship ticket was Herman Michaeline\nMy mother's maiden name was Rosine Bach\nNATURALIZATICE\nRECEIVED\nMy maiden name was (if woman)\nthe\nP\nSEP 10 19281\nBaker\nK\nMy present occcupation is\nMy personal description is: Color, white ; complexion, lightfur ; height, 5 feet\nACKND 53/4\nof inches;\nweight, 156 pounds; color of hair,\nlightbroud\nA\n; eyes,\ncolor of blue\n;\nother visible\ndistinctive marks: the Scar on lift - scarce\nI was born in\nHamburg\nGermany\nFree start\n(CityCor town)\n(Country)\non\nthe 20 day\nof\nAugust\n1 892\n,\nMy present residence is 141 (Number and street) It, (City or norroich, town) now (County) London, (State) Cam\nBrounley\nMy office is Bry 73 73\npost address\nThe place where I took the ship or train which landed me in the United States was Bremen\nGermany\non Obdober\n10. 1924\n,\n(Month)\n(Day)\n(Year)\nThe this bought at Breamen Free Start\nticket on which I came to country was\nmuncher\n(City)\n(Country)\nThe name of the ship or railroad on which I came was\n(OVER) muenchen\nC/A leened c14-8\nNOV 10 1926"
}