All the blanks in this form should be carefully filed 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 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 agent, should be stated. Pensions are, by law, exempted from any liability on account of the obligations of the pensioner, 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. FILED BY P [3-023.] P DECLARATION OF PENSIONER FOR RESTORATION TO THE ROLLS WHO HAS BEEN DROPPED UPON MEDICAL EXAMINATION. who, being duly sworn according to law, makes the following declaration: That he is the identical who was pensioned on the rolls of the agency at is herewith returned; that he was 189-, at the rate of dollars he was dropped from the rolls. still con Believing that the disability for which he was pensioned, to wit, 1 tinues in a pensionable degree, he asks that his name be restored to the pension rolls. That his medical examinations since he became a pensioner have been as follows: 2. and that he has not reenlisted or been paid in the military, naval, or marine service of the United States since the last payment of his pension; that he hereby appoints attorney to prosecute the above claim; that his street, in the residence is at No. State of [Attest.] in and that his post-office address is of county of And personally appeared residing at No. [Claimant's signature.] and -, 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 his name (make his mark) to the foregoing declaration; that they have every reason to believe, from the appearance of said claimant and their acquaintance with him, that he is the identical person he represents himself 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 made known and explained to the applicant and witnesses before swearing, added; and that [L. S.] including the words -, erased, and the words I have no interest, direct or indirect, in the prosecution of this claim. [Signature.] [Official character.] 1 Here state specifically the disability, or disabilities, for which pension is claimed. 2 Here insert the names of the surgeons by whom he has been examined, with the month and year in which examination was made. त FOR RESTORATION OF A PEN- No. of pension certificate, Applicant. FILED BY 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. D [3-013.] D DECLARATION OF A WIDOW FOR ORIGINAL PENSION. STATE OF County of aforesaid, State of A. D. one thousand eight hundred and ninetywithin and for the county and State aged years, a resident of , county 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: on the day of 18-, by to the marriage; that she had to said soldier at ; that there was no legal barrier 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: [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.] residing at residing at and 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 their acquaintance with her of years and 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.] A. D. 189—, and I Sworn to and subscribed before me this day of 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. 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. FILED BY [Signature.] [Official character.] |