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Wrzasj, Bronislaw: Naturalization Record, Petersburg City

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Form 2213 Facts for Declaration of Intention Department of Commerce and Labor Naturalization Service Washington Note.- A copy of this form should be furnished by the clerk of the court to each applicant for a declaration of intention, so that he can at his leisure fill in the answers to the questions. After being filled out the form is to be returned to the clerk, to be used by him in properly filling out the declaration. To the applicant.- The fee of one dollar must be paid to the clerk of the court before he commences to fill out the declaration of intention. Name: Bronislaw Wrzask (Do not abbreviate any part of name by initial or otherwise.) Age: 27 years (Give age at last birthday.) Occupation: Tailor Color: White Complexion: Light Height: Five feet six 1/2 inches Weight: 140 Color of hair: light brown Color of eyes: gray Other visible distinctive marks: none (If no visible distinctive marks so state.) Where born: Dobromil, (City or town.) Austria (Country.) Date of birth: Dec, (Month.) Second, (Day.) 1882 (Year.) Present residence: 12 E. Washington, (Number and street.) Petersburg (City or town.) Va. (State, Territory, or District.) Emigrated from: Antwerp (Port of embarkation.) Belgium (Country.) Name of vessel: Waderland (If the applicant arrived otherwise than by vessel, the character of conveyance or name of transportation company should be given.) Last place of foreign residence: Dobromil (City or town.) Austria (Country) I am now a subject of and intend to renounce allegiance to* (see note.) Franz Joseph I (Name.) Emperor of Austria and Hungary (Title.) Date of arrival in United States: Nov. (Month.), 27 (Day), 1906 (year) Port of arrival: New York (City or town.), N.Y. (State or territory.)

  • Note - If applicant is a citizen of a foreign Republic he should fill in the following line in lieu of the above, writing the name of the Republic only.

I am now a citizen of and intend to renounce allegiance to the Republic of [blank] 11-2580