No. 480                                                  U. S. Department of Labor Naturalization Service     Original 85 [85 looks like a page number]

United States of America

Declaration of Intent

Invalid for all purposes seven years after the date hereof

The State of Nebraska} ss:                                                                                                                                In the District Court

County of Saline}                                                                                                                                         of Saline County Nebraska

I, Frank Chaloupka, aged 47 years, occupation Farmer, do declare on oath that my personal description is: Color white, complexion fair, height 5 feet 9 1/2 inches, weight 155 pounds, color of hair brown, color of eyes blue other visible distinctive marks none

I was born in Velka Bites, Bohemia, Austria on the 24th day of July, anno Domini 1874; I now reside at Dorchester Nebraska

I emigrated to the United States of America from Bremen, Germany on the vessel (do not remember name.); my last foreign residence was Velka Bites, Bohemia Austria; I am married; the name of my wife is Aloisie; she was born at Moravia, Austria and now resides at Dorchester, Nebraska

It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign prince, potentate, state, or sovereignty, and particularly to Czecho Slovak Republic and Austria, 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 28th day of July, anno Domini 1882; 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.          

Frank Chaloupka

(Original Signature of declarant)

Subscribed and sworn to before me in the office of the Clerk of

said Court this 21st day of November, anno Domini 1901.

S. A. Shestak

Clerk of the District Court