U.S. District Court for the Southern District of New York

“ 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:
(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. ”

“ 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. ”

“ DECLARATION OF INTENTION
(Invalid for all purposes seven years after the date hereof)
No. 541593
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. ”