HomeMy WebLinkAboutJuelsrud, Jan - Naturalization Records J .
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ORIGINAL UNITED STATES OF AMERICA
(To be retained by
Clerk of Court)
DECLARATION OF INTENTION No. 201
(Invalid for all purposes seven years after the date hereof)
_STAT.F._DP_PEITI'ISYLYA}IIL ..._ . In the a02Z:0I1_I'LFAS Court
as:0OUT -CR--k'3AIM= __ of FBA.NI IIT -04IINTX at Q ,'B S)31M,-_PA..---
(1) My full,true,and correct name is____11a11__sIu01BrUd
1 North Grant (Vile name.without.b .�cy�. (5* m..hitlti.ils,e ts�t&t.ss..r-1)enna.
(2) My present place of residence is__ 33 • �"
t (Number and street) �j� (City or town Dec,(county) rho(atRW 1 ryt
(3) My occupation is_ Rs til�ator (4) I am Cif' -years old. (6)I was born on 2 _921
(Mouth) `dt t)e (Year)
in_ QS1QQretaY (6) My personal description is as follows:Sex t,CI L
vTrnfi.,, (City or town) C ty.distriet.Droyinoe.oret.n),,, (Country) ?
color t-L .t$ ,complexion l r ,color of eyes flue ,color of hair Blonde height.._5_ ___feet ! __ _inches,weight150 pounds,
visible distinctive marks_____�__ ____ _,race/Scan anaFia i SIi2TlY£a presentnationality
(7) I am__nett__married;the name of my wife or husband is -,. ;we were married on
(Month) (Day) (Year)
at ; he or she was born at
(City oe town) (State or country) (City or town) (County.district.mein..or state) (Country)
on ;and entered the United States at
(Month) (Day) (Year) •
(C1ty or town) (Stab)
on for permanent residence in the United States,and now resides at
(Mouth) (Day) (Year) (City or town) (Count,and State)
(8) I have children;and the name,sex,date and place of birth,and present place of residence of each of said children who is living,are as follows:
(9) My last place of foreign residence was Qs1Q ISQrwa.Y (10) I emigrated to the United States from
may or town) r., (t nty.di t.iet.pro•i°°a es state) (Country)
___ I Ve 00�, �gla $° (11) My lawful entry for permanent residence in the United States was
t(T t� way or town) ) ,. Juel srud
at___1?IL. Q 'k a_�__Nt. under the name of Sri
s1 cite or town)OD 22 1 ,,rQ on the `sr,. $. Bri tanni c
(Dq) ( usq (Name of mesa or other towns of eonvey.nw)
(12) Since my lawful entry for permanent residence I have__ Qt__been absent from the United States,for a period or periods of 6 months or longer,as follows:
DEPARTED FROM THE UNITED STATES RETURNED TO THE UNITED STATES
PORT (M DATE h,day, DATE
VESSEL OR OTHER MEANS PORT (Month,day, VESSEL OR OTHER MEANS
year)on
Or CONVEYANCE year) OF CONVEYANCE
(13) I have_mot_heretofore made declaration of intention: No. ,on_.. at
(Month) (Day) (Year) (Cite or town)
in the
(Count» (Stead (Name of(omt)
(14) It is my intention in good faith to become a citizen of the United States and to reside permanently therein. (16) I will,before being admitted to citizenship
renounce absolutely and forever all allegiance and fidolity to any foreign prince,potentate,state,or sovereignty of whom or which at the time of admission to citizenship
I may be a subject or citizen. (18) I am not an anarchist;nor a believer in the unlawful damage,injury,or destruction of property,or sabotage;nor a disbeliever in
or opposed to organized government;nor a member of or affiliated with any organization or body of persons teaching disbelief in or opposition to organized government.
(17) I certify that the photograph affixed to the duplicate and triplicate hereof is a likeness of me and was signed by me.
I do swear(affirm) that the statements I have made and the intentions I have expressed in this declaration of intention subscribed by me are true to the best of
my knowledge and belief: SO HELP ME GOD.
_...
( and true drnwe. Ithut abbreviation.also other n m.R used)
Pr
Subscribed and sworn to a rmed) before me .. orm of oath shown above in the office of the
Clerk of said Court,at Chambersburg,_ °a,
this ___15.h_ day of J1ua 4- , anno Domini 191 I hereby certify that
Certification No. A 6,� _,g57from the Commissioner of Immigration and Naturalization,
showing the lawful entry for permanent residence of the declarant above named on the date stated in
this declaration of intention,has been received by me,and that the photograph affixed to the duplicate
and triplicate hereof is a likeness of the declarant.
(DO NOTATTACH
OF APHOTOGRAPH
TO THIS
COPY
If;EALI Mrs, Fred. S. Kolb&
kolthe CQ�_ 1 .g
Court.
By-- - ' r
A Deputy Clerk.
Form N-ale
U. S. DEPARTMENT OF JUSTICE ue—tstte-1 U.S.GOVERNMENT PRINTING OF/IC{
IMMIGRATION AND NATURALIZATION SERVICE
(Edition of 11-1-411
JUELSRUD, Jan
DOB 12/21/1921
Vol 3 No 201 Declaration of Intention