The Penn's Grove record., 1921-09-16
DECLARATION OF INTENTION

DECLARATION OF INTENTION
Invalid for all purposes seven
years after the date hereof
Ba aged - years, occu-
patton do declare on oath
lafirm) that my personal descrip-
ton is: Color , complexion
- height - weight -,
color Of hair - color Of eyes
, other visible distinctive marks
-; | was born in - on the
- day of , ammo Domini
; | now reside at -; l
emigrated to the United States Of
sci ; my last foreign resi-
dence was --. 1t is my bona tide
intention to renounce forever all allie
glance and fidelity to any foreign
prince, potentate, state, OF soyer-
eighty, and particularly to-, OF
which [ am a citizen (subject); l
arrived at the (pOrt) of -, in the
State (Territory or DISTRICT Of
ON or about the - day of -
ammo Domini - | am not an an
archist; l am not a polygamist nor a
believer in the practice Of ~polygamy;
and it is my intention in good faith to
become q citizen of the United States
Of America and to permanently reside
therein. So help me God.
Original signature Of d~eclarant)
Subscribed and sworn to affirmed
before me this - day of -
ammo Domini - /. S.
-COficiaI character Of attestor.)
Petition For Naturalization
Court Of
In the matter Of the petition of
- to be admitted as a citizen OF
the United States Of America.
10 the -- Court:
The petition Of -- respectfully
shows;
First. My full name is -
Second. My place Of residence is
No. - State (Territory or Dis
I61ird. My occupation is -
Fourth. | was born on the =
day of , IS, at -,
Fifth. | e~migrated to the United
States from , on or about the
day Of --, l., and ar
at the port of -, in the
United States, ON the vessel -
Sixth. | declared my intention to
become a citizen Of the United States
on the -- day Of -, T., at
in the -- court of .
Seventh. am - married. Ny
name is . She was born
in - and now resides at -
l have - child, and the name,
date, and place of birth and place of
residence Of each of said children is
Eighth. l am not i disbeliever in
or opposed to organized government
or a member of or affiliated with any
organization OF body of persons teach
ing disbelief in organized government.
I am not a polygamist nor a believer
the practice of pOlygamy. | am at
tached to the principles of the Constl-
of the United States, and it IS
my intention to become a citizen OF the
States and to ranounce aoso-
lutely and forever all allegiance and
fidelity to any foreign prince, poten-
state, or sovereignty, and par
ticuIarly to - Of which at this
time | am a citizen Cor subject), and
it is my intention to reside peIman-
in the United States.
Ninth. am - able to speak !.
The English language.
Tenth. I have resided continuously
in the United States Of America for a
term of five years at least immedi-
ltely preceding the date Of this petit
to wit. since day o.,
ammo Domini -
Eleventh. I have not heretofore
made petition for citizenship to any :
q made petition for citizen =.
ship to the - court of - at
. and the said petition was de .
med by the said court for the follow
NC reasons and causes, to wit, -,
and the cause of such denial has since .
been cured or removed.)
Attached hereto and made a part of
This petition are my declaration of IN
-eution 10 become q citizen of the
States and the certificate from
the Department of Labor required by
.aw. Wherefore your petitioner prays
that he may be admitted a citizen Of
the United States Of America.
hl4Ll