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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

[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

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STATE OF On this day of A. D. one thousand eight hundred and ninetypersonally appeared before me, a within and for the county and State aforesaid, aged years, late a member of Co. of

Vol.,

a resident of the

county of

Regiment,
State of

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 Agency at the rate of

[here insert

[state when and where

Pension 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, appoints county of —, State of, his true and lawful attorney to prosecute his claim. That his post-office address is county of

Attest:

of

State of

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[Claimant's signature:]

-; that he

Also personally appeared

residing at

residing at

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

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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.

Sworn to and subscribed before me this

[Signatures of witnesses.]

day of —, A. D., 189—; and I hereby certify that the contents of the above declaration, etc., were fully

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[L.S.] made known and explained to the applicant and witnesses before swearing, including the words that 1 have no interest, direct or indirect, in the prosecution of this claim.

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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 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

[3-022.]

STATE OF
On this

DECLARATION FOR RESTORATION OF PENSION.
[Act of June 27, 1890.]

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personally appeared before me, a

said,

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aged

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sworn according to law, declares:

State of

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 18-.

or naval service of the United States since That he makes this declaration for the purpose of having his pension restored at the rate of dollars per month from

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residing at

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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 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 and 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.

[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.

[L. S.] ing, including the words

[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.

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