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DECLARATION FOR PENSION OF CHILDREN UNDER SIXTEEN YEARS

OF AGE.

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STATE OF County of , ss:
On this
day of

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

of record within and for the county and State aforesaid,

a resident of

county of 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 for children under sixteen years of age: That is the only legal guardian legitimate children of

who 1

under the name of

at -
on the
day of
-, A. D. 184,

in the war of who was discharged and who died 3 at

on the day of -, A. D. 18—; that he left widow surviving the following named are the only surviving legitimate children of said who were under sixteen years of age at the time of his death: of soldier by

born

18– of soldier by

born of soldier by

born

18of soldier by

born

18– of soldier by

born of soldier by

born

18– of soldier by

born

18–. of soldier by

born

18of soldier by

born

18. That the father was married under the name of

to 6 there being no legal barrier to such marriage; that the said children have not aided or abetted the rebellion; and that

- prior application has been filed? that declarant hereby appoints

h- attorney to prosecute the above claim; that h- residence is at No.

street, in the

of county of State of and that hpost-office address is

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[Claimants signature.]

Attest:

Also personally appeared

residing at No. in street, in and residing at No. in 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 name (make mark) to the foregoing declaration; that they have every reason

1“Was enlisted," "drafted,” or otherwise, as the case may be.
2 State company and regiment, if in Army; or vessel, etc., if in Navy..

3 If soldier died in service, so state. If he died after his discharge from service, state cause of death and when and where he contracted the fatal disease or incurred the wound or injury that resulted in his death.

4 If widow survived, so state, giving her name and the date of her death or other facts divesting her title.

5 State names of children and of their mothers, and dates of birth.
6 If more than once married, so state, giving names and dates and parties officiating.

? If either soldier, widow, or guardian of children have previously applied, so state, giving date and number of application.

to believe, from the appearance of said claimant and their acquaintance with that is the identical person

represents 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 swear

ing, 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.]

-, Applicant,

Regt.,

Vols.

MINOR CHILDREN.

CLAIM FOR PENSION.

ORIGINAL.

FILED BY

Co.,

guardian of minors of

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

A discharge from the service in all cases is necessary.

The claimant's identity must be proven by two witnesses, who are present and witness the signature of the declarant, and certify to his identity 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, attor ney, 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 rensioners, 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.

Declarations and 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 certifi. cate 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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[3—016.]

G DECLARATION OF GUARDIAN FOR INCREASE OF PENSION TO

PENSIONED CHILDREN.
STATE OF County of
On this

day of

-, A. D. one thousand eight hundred and ninetypersonally 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 benefit of the provisions of acts of Congress increasing the pensions of orphans: That is the only legal guardian of

-, legitimate children of who was 1 -; that on account of his death they have been granted pension in accordance with the certificate numbered bearing date and which is herewith returned; and that the name and dates of birth of all his legitimate children yet surviving, who were under sixteen years at the date of the father's death, are as follows: of soldier by

born

18of soldier by

born of soldier by

born of soldier by

born of soldier by

born

18of soldier by

born

18–. of soldier by

born of soldier by

born

18–. of soldier by

born That hereby appoints

h- attorney to prosecute the above claim; that h- residence is at No. in street, in the of county of --, State of ---, and that h- post-office address is

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18–. 184, 18–.

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Also personally appeared

residing at No. - in street, in and ---, residing at No. in 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 hname (make mark) to the foregoing declaration; that they have every reason to believe, from the appearance of said claimant and their acquaintance with that - is the identical person represents --self 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 rank, company, and regiment, if in Army; or rank, vessel, &c., if in Navy. · State names of children and of their mothers, and dates of birth.

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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 judicia 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.

H

[3—017.)

H

DECLARATION FOR AN ORIGINAL PENSION OF A MOTHER.

SS:

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on the

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STATE OF

County of On this day of A. D. one thousand eight hundred and ninetypersonally 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 granting pensions to dependent mothers : That she is thel

of
and mother of

who2 under the name of

at

day of

A. D. 184, in 3 in the war of

who 4
on the
day of

A. D. 18—; that said son left neither widow nor child under sixteen years of age surviving; that she was dependent upon said son for support; that her husband, the aforesaid

aged years ---; that there were surviving, at date of said son's death, his brothers and sisters, who were under sixteen years of age, as follows:

born
born
born

18%
born

18That she has not heretofore received applied for a pension she has not aided or abetted the rebellion; that she hereby appoints her attorney to prosecute the above 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

, per

Also personally appeared

residing at No.

street, in and

--, residing at No. in street, in sons 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.]

2 66

1“ Wife"

or “widow." Enlisted,

was drafted," etc. * State company and regiment, if in the Army; and vessel, etc., if in the Navy. “State nature of wounds and all circumstances attending them, or the disease and manner in which it was incurred, in either case showing soldier's death to have been the sequence; also service and rank at time of death.

5" Wholly” or “in part."

6 If husband is dead, so state, giving date of death; also whether applicant has remarried. If still living, his inability to support applicant should be accounted for.

'If either she or the soldier has previously applied, so state, giving number of claim.

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