TRIPLICATE
(To be given to declarant when originally issued; to be made a part of the petition for naturalization when petition is filed; and to be retained as a part of the petition in the records of the court)
TC
UNITED STATES OF AMERICA
DECLARATION OF INTENTION
(Invalid for all purposes seven years after the date hereof)
No. 541593
| STATE OF NEW YORK | SS: |
| SOUTHERN DISTRICT OF NEW YORK |
In the DISTRICT Court
of UNITED STATES at NEW YORK, N. Y.
(1) My full, true, and correct name is (Full, true name, without abbreviation, and any other name which has been used, must appear here)JULES BRYNER Also Youl Bryner
(2) My present place of residence is (Number and street) (City or town) (County) (State)Hotel Gorban 136 West 55th St. NY NY NY
(3) My occupation is xx Actor and Radio Announcer (4) I am 22 years old. (5) I was born on (Month) (Day) (Year)July 11th, 1920
in (City or town) (County, district, province, or state)Vladivostock Syberia Russia (6) My personal description is as follows: Sex Male
color White, complexion Fair, color of eyes Brown, color of hair Dk Brown, height 5 feet 10 inches, weight 180 pounds,
visible distinctive marks None, race White, present nationality Swistzerlerland
(7) I am Not married; the name of my wife or husband is ; we were married on (Month) (Day) (Year)
at (City or town) (State or country); he or she was born at (City or town) (County, district, province, or state) (Country)
on (Month) (Day) (Year); and entered the United States at (City or town) (State)
on (Month) (Day) (Year) for permanent residence in the United States, and now resides at (City or town) (County and State)
(8) I have No 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 (City or town) (County, district, province, or state) (Country)Dairem South Manchuria (10) I emigrated to the United States from
(City or town) (Country)Kobe Japan (11) My lawful entry for permanent residence in the United States was
at (City or town) (State)San Francisco x California under the name of Jules Bryner
on (Month) (Day) (Year)October 25th, 1940, on the (Name of vessel or other means of conveyance)S President Cleveland
(12) Since my last lawful entry for permanent residence I have Not 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 |
Date (Month, day, year) |
Vessel or Other Means of Conveyance |
Port |
Date (Month, day, year) |
Vessel or Other Means of Conveyance |
| | | | | | |
| | | | | | |
| | | | | | |
(13) I have Not heretofore made declaration of intention: No. , on (Month) (Day) (Year) at (City or town
(County) (State) in the (Name of court)
(14) It is my intention in good faith to become a citizen of the United States and to reside permanently therein. (15) I will, before being admitted to citizenship, renounce absolutely and forever all allegiance and fidelity 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. (16) 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 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.
Subscribed and sworn to (affirmed) before me in the form of oath shown above in the office of the Clerk of said Court, at New York NY this 4th day of June, anno Domini 1943, I hereby certify that Certification No. 24 1-364643 from 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.
GEORGE J. H. FOLLNER
Clerk of the CourtU. S. DISTRICT
By 
Form N-315
U. S. DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
(Edition of 11-1-41)