FORM OF DECLARATION, ETC.. FOR SURVIVING CHILDREN.
ACT 7TH JUNE, 1832.

On this. appeared.

.day of..

A. D. 185

County of.

.and State of..

held within and for the County and State aforesaid, personally aged....years, a resident of... .in the ; who being duly sworn according to law, doth on his oath make the following declaration, in order to obtain the benefits of the provisions of the act of 7th June, 1832: That he is one of the children and heirs at law of.... .. deceased, who was a..

company..

commanded by.

.in the

.commanded by Captain..... ...in the regiment.......

.in the War of the Revolution.

That his said father (as he believes) entered the service at. the.......day of.. A. D. 17..; for the term of.. tinued in actual service in said War, for the term of.. honorably discharged at.. A. D. 17....That he was in the following engagements, viz.

on the....

.day of.

....about .and con.and was

. That he served under

the following named officers in addition to the above, viz:....

.That he has no documentary evidence of .; who died on the 18....That the following are the only surviving

his service. That he left a widow named..
.day of..
children of the said soldier, viz:
That his mother was married to the said.
of...
: on the............day of..

was.

day of.

.a..

in.

State A. D. 18 ; by one .and that her name before her said marriage . on the..

; that his father died at.. A. D. 18

And further, that there is.

public record of her marriage-and that

there is.......private record of her marriage.... He hereby appoints....

his true and lawful Attorney, with power of substitution, to prosecute his claim, to receive the Certificate when issued, and to do all other acts necessary and proper in the premises.

WITNESS: ...

SWORN TO AND SUBSCRIBED before me, on the day and year first above mentioned, and I hereby certify that I know the said deponent

and believe him to be as is above stated, and that he is of the age above stated; and further, that I am not interested in this claim as Attorney or otherwise. Witness my hand and the seal of said Court, affixed

appeared before the subscriber, a Justice of the Peace, in and for the County aforesaid, duly authorized to administer oaths,.

a resident of said County, to me well known as a credible witness, and who being by me first duly sworn, doth on his oath state that he was acquainted with Mrs..... above named-that he knew her for.. years before her death, that he has examined her family record--that he believes the same to be genuine-that it is contained in a book purporting to be the " and printed in the year..... .; and that the said record, as ..of the death of herself

66

STATE OF.
COUNTY OF.

On this.

88.

..day of...

.A. D 185 , personally appeared before me, the undersigned, a Justice of the Peace, in and for said County, ...and. who are to me well known, and who are credible witnesses, and who being by me duly sworn, depose and say, that they were each well acquainted with Mrs....

..that they knew her for..

they were acquainted with...

years prior to her death. That .her late husband, having known him for

years previous to his death; that they, the said.........and..... lived together as husband and wife, and were reputed so to be, that deponents never heard the fact of their marriage disputed or questioned. That the said

..died on the...

died on the... . . . . . .day of..

.day of..
.A. D. 18

.18; and the said.. and that the following named

are the only surviving children of the said soldier, viz:..

WITNESS :...

It is hereby certified that satisfactory evidence has been exhibited before the said Court, which evidence is hereto annexed;

That..

..., who as reputed, was a Revolutionary soldier of the United States, died on the.. .day of........eighteen hundred and..... leaving surviving him a widow named.

who died on the... day of ..are the only surviving childin the State

.A. D. 18 and that. ren of the aforesaid soldier, who are residents of.. of..

IN TESTIMONY WHEREOF, I have hereunto by order of said Court, set my hand and affixed my seal of office this.... .day of.. one thousand eight hundred and fifty

Clerk.

On this...... day of

A. D. 185. ., before the Court of

held within and for the County and State aforesaid, personally appeared aged...... years, a resident of..

State of.

..in the County of.

.and

.; who being duly sworn according to law, doth on his oath make the following declaration in order to obtain the benefits of the provisions of the act of 7th June, 1832: That he is the Administrator of.. deceased, who was a...... .in the company....commanded by Captain.... in the regiment....commanded by.

That the said.

in the War of the Revolution.

.entered the service at .....about the.....day of

.A. D. 17..; for the term of. in said War for the term of.

...... on the..

following engagements viz:

.day of

. and continued in actual service .and was honorably discharged at .A. D. 17..; that he was in the

That he served under the following named officers in addition to the above, viz: ..; That there is no documentary evidence of his service; that he left a widow, named.......who died on the........day of.. A. D. 18 That the following are the only surviving children of the said soldier, viz: ; that he was married to the said

that there is.... private record of his marriage..

He hereby appoints..

his true and lawful Attorney, with power of substitution, to prosecute this his claim, to receive the Certificate when issued, and to do all other acts necessary and proper in the premises.

WITNESS:

......

SWORN TO AND SUBSCRIBED before me, on the day and year first above mentioned, and I hereby certify that I know the said deponent.... and believe him to be as is above stated, and that he is of the age above stated; and further, that I am not interested in this his claim as Attorney or otherwise. Witness my hand, and the seal of said Court, affixed by order of said Court, now in session.

Clerk.

STATE OF.. COUNTY OF..

}

$8.

On this......day of.. .A. D. 185.., personally appeared before the subscriber, a Justice of the Peace, in and for the County aforesaid, duly authorized to administer oaths,.. a resident of said County, to me well known as a credible witness, and who, being by me first duly sworn, doth on his oath state that he is acquainted with Mrs.... ......above named; that he knew her for.......years before her death; that he has examined her family record; that he believes the same to be genuine; that it is contained in a book purporting to be the "..... " and printed in the year..... record, as far as relates to the marriage of the said... named, and of their death; and the names and date of the is as follows, which is an exact copy of the same;. deponent is not interested in the claim.

SUBSCRIBED AND SWORN TO, the day and year first above written, before me, and I certify that I am in no manner interested.

.; and that the said and the soldier above birth of their children ..and that the said

}

Justice of the Peace.

surviving him a widow, named.

A. D. 18 ; and that..

who died on the......day of .are the only surviving ..has been duly

children of the aforesaid. And further that. appointed by proper authority under the laws of said State, Administrator of the said..... ... deceased: having executed with good and sufficient sureties a bond in the penal sum of $.....conditioned for the faithful performance of his duties as such Administrator, and that his letters of Administration are in full force.

IN TESTIMONY WHEREOF, I have hereunto, by order of said Court, set my hand and affixed my seal of office this......day of.

thousand eight hundred and fifty

..onc

Clerk.