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Form 2213
PRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN
5294
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
upper left-hand corner of all copies of
CARD INDEX
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.
Felikks Jasinski
44
; age,
years.
Miss
(Afierr should print or typewrite here true, original, and correet name)
(Give age last birthday)
My present occupation is
Splinner - factory
81/4
My personal description Color, froms complexion, light ; height, 5 feet $ inches;
is:
weight,
150 pounds; color of hair brown ; color of eyes, bluegray
other visible
I was born in Wysokie (City Mazowieckie, town) now Poland- (Country)
distinctive Partofuthinuth marks: sighthang injured ruiting
Russian
or
on the 5
day of November
1883
My present residence is
221- Str,
norwich Conn
(Number and street)
(City or town)
(County)
(State)
The place where I took the ship or train which landed me in the United States was
Under 13- 1906.
Hambuzg
germany
on
The of the ship railroad which I was Patricia (Month) -
(Day)
(Year)
name or on came
My last
place of foreign residence paid was (City or town) mazowieckie Driffin Country) Poland,
Wysokie
wife
Sophia Jusiystic
She
paintay I am yes married. The name of my
is
was born at
Wysokic Mazowieckic, husband , and now resides aid
Hee
at 221 S.Thamestomaid
A
I
am now a subject of and intend to renounce allegiance to Republic (Write of sovereign Poland and country of which
name and title of now a subject;
I
or, arrived if citizen at of a the republic, United write name States of republic immigration only) port of new york
n.y.
on 24 March, (City 1906-
or town)
,
(State or territory)
14-8
(Give exact month, day, and year)
(OVER)
Page data
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- Source index
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- Type
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- Size
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Document data
- ID
- 159596813
- Core
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- Type
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DTO data
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Context sent to Scholar
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"ocrText": "Form 2213\nPRELIMINARY FORM FOR DECLARATION OF INTENTION TO BECOME A CITIZEN\n5294\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\nupper left-hand corner of all copies of\nCARD INDEX\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.\nFelikks Jasinski\n44\n; age,\nyears.\nMiss\n(Afierr should print or typewrite here true, original, and correet name)\n(Give age last birthday)\nMy present occupation is\nSplinner - factory\n81/4\nMy personal description Color, froms complexion, light ; height, 5 feet $ inches;\nis:\nweight,\n150 pounds; color of hair brown ; color of eyes, bluegray\nother visible\nI was born in Wysokie (City Mazowieckie, town) now Poland- (Country)\ndistinctive Partofuthinuth marks: sighthang injured ruiting\nRussian\nor\non the 5\nday of November\n1883\nMy present residence is\n221- Str,\nnorwich Conn\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\nUnder 13- 1906.\nHambuzg\ngermany\non\nThe of the ship railroad which I was Patricia (Month) -\n(Day)\n(Year)\nname or on came\nMy last\nplace of foreign residence paid was (City or town) mazowieckie Driffin Country) Poland,\nWysokie\nwife\nSophia Jusiystic\nShe\npaintay I am yes married. The name of my\nis\nwas born at\nWysokic Mazowieckic, husband , and now resides aid\nHee\nat 221 S.Thamestomaid\nA\nI\nam now a subject of and intend to renounce allegiance to Republic (Write of sovereign Poland and country of which\nname and title of now a subject;\nI\nor, arrived if citizen at of a the republic, United write name States of republic immigration only) port of new york\nn.y.\non 24 March, (City 1906-\nor town)\n,\n(State or territory)\n14-8\n(Give exact month, day, and year)\n(OVER)"
}