AA - within and for the county and State afore aged years, a resident of county of State of who, being duly sworn according to law, declares that he is the identical person who was enrolled at under the name of in on the day of 18-. 18-. on the day of [here give a That he was not employed in That he has not been employed That his personal description feet years; height, That he is inches; com[wholly or in part] 18-, as a [here state rank and company and regiment in the Army, or vessel, if in the Navy] in the service of the United States, in the war of the rebellion, and served at least ninety days, and was honorably discharged at 18. That he also served complete statement of all other services if any]. the military or naval service prior to in the military or naval service since at enlistment was as follows: Age, plexion, -; hair, ; eyes, incapacitated for earning a support by manual labor by reason of name the disease or injuries by which disabled]. That said disabilit— due to his vicious habits, and to the best of his knowledge and belief of a permanent character. That he is a pensioner. That he has heretofore applied for pension. [If a pensioner, the certificate number only need be given. If not, give the number of the former application if one was made.] That he makes this declaration for the purpose of being placed on the pension roll of the United States under the provisions of the act of June 27, 1890. That he hereby appoints prosecute his claim. That his post-office address is -, 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 his name (or 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 of years, respectively, that he is the identical person he represents himself to be; and that they have no interest in the prosecution of this claim. 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 made known and explained to the applicant and witnesses before swearing, 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 STATE OF [3-011a.] DECLARATION FOR INCREASE OF PENSION. [Under the act of June 27, 1890.] [The pension certificate should not be forwarded with the application.] -, County of · day of On this personally appeared before me, a said, Vol., A. D. one thousand eight hundred and ninety- aged years, late a member of Co. who, being duly sworn according to law, declares that he is a pensioner of the United States under the act of June 27, 1890, enrolled at the Pension Agency at the rate of dollars per month, by reason of partial inability to earn a support by manual labor, his pension certificate being numbered That he believes himself to be entitled to an increase of pension on account of the disabilities heretofore alleged, namely, [here insert the disabilities alleged in original and subsequent declarations]. Also on account of the disabilities not previously alleged] incurred disabilities originated, and if wounds or injuries, give circumstances of incurrence]. That none of said disabilities are due to vicious habits, and that they are to the best of his knowledge and belief of a permanent character, of county of -; that he appoints his true and lawful attorney to prosecute his claim. That his post-office address is county of residing at -, 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 (or 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. - 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. 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 Bureau of Pensions 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. This declaration and any testimony in support of the allegations made therein may be executed before any officer authorized to administer oaths for general purposes in the State, city, or county where said officer resides. FILED BY STATE OF aged said, years, late a member of Co. a resident of -, county of State of sworn according to law, declares: That he was a pensioner of the United States at the rate of month under the act of June 27, 1890, until Regiment, who, being duly dollars per 189-, when his pension was [reduced or discontinued] on the ground that such action was improper for the following reasons: his pension certificate is That he believes That the number of That he has not been employed in the military or naval service of the United States since dollars per month from That he appoints attorney to prosecute his claim. That his post-office address is Attest: [Claimant's signature.] (1) (2) 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 his name (or 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 of years, respectively, that he is the identical person he represents himself to be, and that they have no interest in the prosecution of this claim. years and [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 made known and explained to the applicant and witnesses before swearerased, and the words added, and that I have no interest, direct or indirect, in the prosecution of this claim. [Signature.] [Official character.] 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 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. |