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All the blanks in this form should be carefully filled and the requirements of the notes strictly observed.

An honorable discharge from the service in all cases is necessary.

Declarations of claimants, either for original pension or for increase of pension already granted, must be made before a court of record, or before some officer thereof having custody of its seal, said officer being fully authorized and empowered to administer and certify any oath or affirmation relating to any pension or application therefor.

The claimant's identity and loyalty must be proven by two witnesses, certified by the judicial officer to be respectable and credible, who are present and witness the signature of the declarant, and certify to his identity and loyalty under oath or affirmation.

Declarations and other papers should be as legible and as clear in statement as possible. Where any evidence is already on file in any Department of the Government, a definite description of and specific reference to it will render it available in any subsequent claim.

The post-office address (naming street and number in all large cities) of the applicant, attorney,

and witnesses should be embodied in or accompany every application, and all evidence in each claim; and each change of residence of said parties while communicating with the Pension Office or the pension agents should be stated.

Pensions are, by law, exempted from any liability on account of the obligations of the pensioners, and no lien upon them can be recognized.

All facts, testimony of which is required to establish a claim, must be proven by the affidavits of two or more credible witnesses, unless other evidence is specified.

The statements of claimants, unless duly corroborated, are not accepted as evidence.

Testimony in support of allegations made in a declaration may be taken before any officer whose authority and signature are duly certified, and who shall disclaim any interest, direct or indirect, in the prosecution of the claim.

Persons desiring to complete claims pending at the decease of the claimants must furnish a duly verified certificate of their authority as heirs or legal representatives.

With all claims for arrears, increase, or restoration to the rolls, the original pension certificate must be returned or explanation of its absence must be given under oath.

To facilitate the adjudication of claims, all the requisite evidence that is available should be forwarded with the application.

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on the

STATE OF County of
On this
day of

A. D. one thousand eight hundred and ninety, personally appeared before me, a within and for the county and State aforesaid,

aged
years, a resident of

county of State of who, being duly sworn according to law, makes the following declaration in order to obtain pension under the acts of Congress granting pension to the widows of soldiers and sailors who have died by reason of wound or injury received, or disease contracted, in the service of the United States and in the line of duty: That she is the widow of

who was

[enrolled or commissioned] under the name of

at
on the

day of 18—, as a

in [here state rank and designation of organization or name of vessel], and was discharged on the

day of

-, 18—, and who died at

day of — , 18—, of – [here state the immediate cause of death] due to incurred in the above-named service. That she was married under the name of

to said soldier at on the day of 18—, by

that there was no legal barrier to the marriage; that she had been previously married; that the soldier had

been previously married [if there was a prior marriage of either, the date and place of death or divorce of former consort or consorts should be stated). That she has remarried since the death of the said soldier. [If remarried, the date and place of remarriage should be stated.]

That the said soldier left the following-named children under sixteen years of age at the date of his death, to wit:

born

, 18—, at born

18—, at born

18—, at born

at born

18–, at born

18–, at

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18–,

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[If any child has died since the soldier's death, its name and the date of its death should be stated. If the soldier left no children, the claimant should so state.] That she has heretofore applied for pension

[If prior application has been made, the number thereof, the service on which it was based, and the name of the soldier should be stated.] That she hereby appoints

of her true and lawful attorney, to prosecute this claim. That her post-office address is county of

State of

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[Claimant's signature.]

Attest:

(1)
(2)

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Also personally appeared

-, residing at and residing at persons whom I certify to be respectable and entitled to credit, and who, being by me duly sworn, say they were present and saw the claimant, sign her name (or make her mark) to the foregoing declaration; that they have every reason to believe, from the appearance of said claimant and

years and

their acquaintance with her of

years, respectively, that she is the identical person she represents herself to be; and that they have no interest in the prosecution of this claim.

[Signatures of witnesses.] Sworn to and subscribed before me this

day of

A. D. 189—,

and I hereby certify that the contents of the above declaration, etc., were fully [L. s.] made known and explained to the applicant and witnesses before swearing,

including the words erased, and the words — added; and that I have no interest, direct or indirect, in the prosecution of this claim.

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To be executed before some officer of a court of record having custody of its seal, a notary public, justice of the peace, or other officer authorized to administer oaths for general purposes. If such officer is not required by law to have and use a seal, his official character, signature, and term of office must be certified by the proper State, county, or city officer under his official seal, unless such a certificate has been filed in the Bureau of Pensions for general reference.

Testimony in support of allegations made in a declaration may be taken before any officer whose authority and signature are duly certified, and who shall disclaim any interest, direct or indirect, in the prosecution of the claim.

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DECLARATION OF A PENSIONED WIDOW FOR INCREASE OF PENSION.

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STATE OF

County of On this

day of

-, A. D. one thousand eight hundred and ninety-personally appeared before me

the same being a court of record within and for the county and State aforesaid,

a resident of

county of in the State of -, aged years, who, being duly sworn according to law, makes the following declaration in order to obtain the pension provided by acts of Congress increasing the pensions of widows: That she is the widow of

who was a

in in the war of -; that on account of his death she has been granted a pension of dollars per month, in accordance with a certificate numbered bearing date — and which is herewith returned; that she has not remarried since the death of her husband above named; that the following are the names and dates of births of all his legitimate children yet surviving, and were under sixteen years of age at the father's death, to wit:

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That she has not abandoned the support of any one of his children, but that they are still under her care or maintenance ? ; that she hereby appoints her attorney to prosecute her claim; that her residence is at No. in street, in the

of county of State of and that her post-office address is

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[Claimant's signature.]

[Attest.)

-,in

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Also personally appeared

, residing at No. in street, in and - residing at No.

street, in

-, persons whom I certify to be respectable and entitled to credit, and who, being by me duly sworn, say that they were present and saw

the claimant, sign her name (make her mark) to the foregoing declaration; that they have every reason to believe, from the appearance of said claimant and their acquaintance with her, that she is the identical person she represents herself to be; and that they have no interest in the prosecution of this claim.

[Signatures of witnesses.] Sworn to and subscribed before me this day of -, A. D. 189—, and I

hereby certify that the contents of the above declaration, &c., were fully [L. S.] made known and explained to the applicant and witnesses before swearing,

including the words erased, and the words — added; and that I have no interest, direct or indirect, in the prosecution of this claim.

[Signature.]

[Official character.) 1 State company and regiment, if in Army; or vessel and rank, if in Navy. 2 For such children as are not under her care claimant should account.

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All the blanks in this form should be carefully filled and the requirements of the notes strictly observed.

An honorable discharge from the service in all cases is necessary.

Declarations of claimants, either for original pension or for increase of pension already granted, must be made before a court of record, or before some officer thereof having custody of its seal, said officer being fully authorized and empowered to administer and certify any oath or affirmation relating to any pension or application therefor.

The claimant's identity and loyalty must be proven by two witnesses, certified by the judicial officer to be respectable and credible, who are present and witness the signature of the declarant, and certify to his identity and loyalty under oath or affirmation.

Declarations and other papers should be as legible and as clear in statement as possible.

Where any evidence is already on file in any Department of the Government, a definite description of and specific reference to it will render it available in any subsequent claim.

The post-office address (naming street and number in all large cities) of the applicant, attorney, and witnesses should be embodied in or accompany every application, and all evidence in each claim; and each change of residence of said parties, while communicating with the Pension Office or the pension agents, should be stated.

Pensions are, by law, exempted from any liability on account of the obligations of the pensioners, and no lien upon them can be recognized.

All facts, testimony of which is required to establish a claim, must be proven by the affidavits of two or more credible witnesses, unless other evidence is specified.

The statements of claimants, unless duly corroborated, are not accepted as evidence.

Testimony, in support of allegations made in a declaration, may be taken before any officer whose authority and signature are duly certified, and who shall disclaim any interest, direct or indirect, in the prosecution of the claim.

Persons desiring to complete claims pending at the decease of the claimants must furnish a duly verified certificate of their authority as heirs or legal representatives.

With al ims for arrears, increase, or restoration to the rolls, the original pension certificate must be returned, or explanation of its absence must be given under oath.

To facilitate adjudication of claims, all the requisite evidence that is available should be forwarded with the application.

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