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United States of America

A. B., being duly sworn, doth depose and say, that he is a resident in the State of New York, and intends always to reside in the United States, and to become a citizen thereof as soon as he can be naturalized, and that he has taken such incipient measures as the laws of the United States require, to enable hin. to obtain naturalization. Sworn before me, the day of, 18—.

A. B., Clerk of the U. S. District Court.