Form 2903
U. S. DEPARTMENT OF LABOR
NATURALIZATION SERVICE
TRIPLICATE
(To be given to the person making the declaration)
No 10674.
UNITED STATES OF AMERICA
DECLARATION OF INTENTION
Invalid for all purposes seven years after the date thereof
STATE OF PENNSYLVANIA, COUNTY OF LUZERNE SS: In the COMMON PLEAS Court of LUZERNE COUNTY, PA
I Michael Pawlak, aged 26 years, occupation Laborer, do declare on oath that my personal description is: Color White, complexion Dark, Height 5 feet 8 inches, weight 155 pounds, color of hair Brown, color of eyes Gray, other distinctive marks First finger amputated
I was born in Pulgrzymka Austria on the 13 day of January, anno Domini 1893; I now reside at 40 North St., Hudson, Pa
(Give number, street city or town, and State)
I emigrated to the United States of America from Antwerp Belguim on the vessel Kronland; my last foreign residence was Pulgrzymka Austria;
(If the alien arrived otherwise than by vessel, the character of conveyance or name of transportation company should be given)
I am _____ married; the name of my wife is Eva; she was born at Hudson, Pa. and now resides at 40 North St., Hudson, Pa.
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign prince, potentate, state, or sovereignty, and particularly to Austria-Hungary or any Ind. State within the bounds of the former Austro-Hungary Empire, of whom I am now a subject; I arrived at the port of New York, in the State of New York, on or about the 29 day of Feb., anno Domini 1912; I am not an anarchist; I am not a polygamist nor a believer in the practice of polygamy; and it is my intention in good faith become a citizen of the United States of America and to permanently reside therein: SO HELP ME GOD.
Michael Pawlak
(Original signature of declarant)
Subscribed and sworn to before me in the office of the clerk of said court this 19 day of Jan, anno Domini 1920
EVAN J. WILLIAM, Jr. Clerk of the COMMON PLEAS Court.
By D. W. Parnell, Clerk