Form 2203
U. S. DEPARTMENT OF LABOR TRIPLICATE
NATURALIZATION SERVICE (To be given to the person making
the Declaration)
No. 402
UNITED STATES OF AMERICA
DECLARATION OF INTENTION
Invalid for all purposes seven years after the date hereof
State of Ohio In the Common Pleas Court
ss:
Athens County of Athens County
I, Zigmond Kozma , aged 40 years,
occupation miner , do declare on oath that my personal
description is: Color white , complexion Dark , height 5 feet 8 inches,
weight 163 pounds, color of hair Brown , color of eyes Brown
other visible distinctive marks
I was born in Cocke, Hungary
on the 25 day of January , anno Domini 1878 ; I now reside
at Millfield, Ohio
(Give number, street, city or town, and State.)
I emigrated to the United States of America from Hamburg Germany
on the vessel Graf Valdersee ; my last
(If the ailen arrived otherwise than by vessel, the character of conveyance or name of transportation company should be given
foreign residence was Cocke ; I am married; the name
of my wife is Julia ; she was born at Cocke, Hungary
and now resides at Millfield, Ohio
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
prince, potentate, state, or sovereignty, and particularly to Charles V Empour
of Austria & King of Hungary , of whom I am now a subject;
I arrived at the port of New York , on or about the 14 day
of May , anno Domini 1904 ; 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
to become a citizen of the United States of America and to permanently reside therein:
SO HELP ME GOD.
Zigmond Kozma
(Original signature of declarant)
Subscribed and sworn to before me in the office of the Clerk of
said Court this 15 day of Jan anno Domini 191 8
[SEAL] M. B. Copeland
Clerk of the Common Pleas Court.
by Eleanor Overholtzer , Deputy Clerk.