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Sworn to and subscribed before me this

day of --, A. D. 18—, 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.

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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 affir-
mation 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 descrip-
tion 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 pen.
sioners, 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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[Signatures of witnesses.]

1 State company and regiment, if in the Army; and vessel, &c., if in the Navy.

2 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.

3 State company or regiment, if in the Army; and vessel, &c., if in the Navy.

4 "Wholly,” or “in part.”

5 If either he, the mother, or the soldier has previously applied, so state, giving the number

of the claim.

6661- -13

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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 affirma-

tion 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 descrip-

tion 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 pen-

sioners, 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.

Furnishing this blank as requested does not indicate that there is a valid claim to pension.

That fact can be ascertained only after all the necessary evidence has been filed. It must

appear that the soldier died of injury received or disability contracted while in the military or

naval service.

[3_019.]

DECLARATION FOR PENSION OF DEPENDENT BROTHERS AND

SISTERS.

SS:

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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 for dependent brothers and sisters: That is the only legal guardian of · brothers and sisters

who 1. - under the name of

at

day of

A. D. 18—,? in the war of

who died 3

at
on the
day of

A. D. 18—, and who bore at the time of his death the rank of in 4

that he left neither widow, minor child, nor 5 that the above named are the only legitimate brothers and sisters, including those of the half-blood, of the said deceased

surviving, who were under sixteen years of age at the time of his death and were dependent upon him, of whom 6.

that said brothers and sisters were the issue of the parents of said soldier, as follows, the dates of their births being as herein stated:? child of

and

born child of

and

born child of

and

born child of

and

born child of

and

born

184. That the parents were married under the names of 8 there being no legal barrier to such marriage; that none of said brothers or sisters have aided or abetted the rebellion; that prior application has been filed; o 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– 18– 18– 18–

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[Claimant's signature.]

[Attest.]

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Also personally appeared

residing at No.

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

1“Was enlisted," "drafted,” or otherwise, as the case may be.

State company and regiment, if in Army; or vessel, &c., if in Navy. 3 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.

4"In the service aforesaid," or otherwise, as may have been the case.

5 If mother or father survived the soldier and subsequently died, so state, giving date of death; otherwise add “mother nor father surviving."

• If any have died state date of death.
7 State names of children and of both parents, also date of birth.
8 Give names of parents and places and dates of marriages.

'If either soldier or his father or mother have previously applied, so state, giving date and number of application,

that is the identical person represents --self to be; and that they have no interest in the prosecution of this claim.

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[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.

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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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