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duly sworn, say that they were present and saw sign her name [or make her mark] to the foregoing declaration, and they further swear that they have every reason to believe, from the appearance of the applicant 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.

(Signature of witnesses.)

Sworn to and subscribed before me, this

day of A. D. 186–; and I hereby certify that I have no in

terest, direct or indirect, in the prosecution of this claim.

(Signature of judge or other officer.)

Applicant's post-office address.

C.

Form of Declaration for Minor Children, in order to obtain Army Pension.

State (Territory, or District) of

On this

County of
day of

peared before the

in the county of

District) of

-, aged

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of the

88.

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A B, a resident of

and State (Territory, or

de

years, who, being first duly sworn according to law, doth on oath make the following declaration, as guardian of the minor child of ceased, in order to obtain the benefits of the provision made by the act of Congress approved July 14th, 1862, granting pensions to minor children, under sixteen years of age, of deceased officers or soldiers; that he is the guardian of [naming the minor child or children, his ward or in company com

wards], whose father was a

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in

day of

on the
cause of death]; that the mother of the child

-, in the year

[here state the

afore

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as follows:

said, died [or, again married, being now the wife of -]

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date of the birth of his said ward

He further declares that the parents of his said ward

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Sworn to and subscribed on the day and year first above written, before; and I hereby certify that I have no interest, direct or indirect, in the prosecution of this claim. (Signature of judge or other officer.)

D.

Form of Declaration for Mothers applying for Army Pensions.

State (Territory, or District) of

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of in the county of

District) of

who was a
in the

aged

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88.

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A B, a resident

and State (Territory, or

years, who, being first duly

sworn according to law, doth on her oath make the following declaration, in order to obtain the benefits of the provisions made by the act of Congress approved July 14th, 1862 that she is the widow of and mother of in company, commanded by regiment of— in the war of 1861, who [here state the time, place, and cause of death]. She further declares that her said son, upon whom she was. wholly or in part dependent for support, having left no widow or minor child under sixteen years surviving, declarant makes this application for a pension under the above

mentioned act, and refers to the evidence filed herewith, and that in the proper department, to establish her claim.

She also declares that she has not, in any way, been engaged in, or aided or abetted, the rebellion in the United States; that she is not in the receipt of a pension under the second section of the act above mentioned, or under any other act, nor has she again married since the death of her son, the said (Declarant's signature.)

and

Also personally appeared residents of [county, city, or town], 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 sign her name [or make her mark] to the foregoing declaration; and they further swear that they have every reason to believe, from the appearance of the applicant and their acquaintance with her, that she is the identical person she represents herself to be. (Signature of witnesses.)

Sworn to and subscribed before me, this

day of , A. D. 186-; and I hereby certify that I have no interest, direct or indirect, in the prosecution of this claim. (Signature of judge or other officer.)

E.

Form of Declaration of Orphan Sisters for Army Pensions.

State (Territory, or District) of

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aged

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88.

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of in the county of and State (Territory, or District) of years, who, being first duly sworn according to law, doth on oath make the following declaration, in order to obtain a pension under the act of July 14th, 1862: that he is the legally appointed guar

and

dian of [here give the names and ages of his ward or wards], who the only surviving child-, under sixteen years of age, of his wife, and sisterin company commanded regiment of, in the war

of

by

who was in the

of 1861, who [here state the time, place, and cause of his death]. That the brother of his said ward-, upon whom they were wholly or in part dependent for support, having left no widow, minor child or children, or mother, declarant, as guardian, and on behalf of his ward-, refers to the accompanying evidence, and such as may be found in the department, to establish her (or their) claim under the law above named.

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He further declares that his said ward not in the receipt of any pension under said act.

(Guardian's signature.)

Sworn to and subscribed before me, this

day of

A. D. 186–; and I hereby certify that I have no interest, direct or indirect, in the prosecution of this claim. (Signature of judge or other officer.)

F.

The form of certificate of civil surgeons is here omitted, as the appointment of examining surgeons by the Pension Office obviates the necessity for examinations by any others.

NAVY FORMS.

A.

Form of Declaration for a Navy Invalid Pension.

State (District, or Territory) of

88.

County of

On this

dred and

day of
personally appeared before me,-

A. D. one thousand eight hun[here

state the official character of the person administering the oath], within and for the county and State aforesaid, A B, aged in the State of

years, a resident of

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who, being duly sworn according to law, declares who enlisted in the naval

that he is the identical

service of the United States at

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; that his personal description is as follows: [here state height, complexion, color of hair, occupation, &c.]; that while in the service aforesaid, and in the line of his duty, he received the following wound [or other disability, as the case may be]: [Here give a particular and minute account of the wound or other injury, and state how, when, and where it occurred, where the applicant has resided since leaving the service, and what has been his occupation]. He makes this application in order to secure the benefits of the act granting pensions, approved July 14th, 1862.

(Signature of claimant.)

and

residents

Also personally appeared of [county, city, or town], 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 sign his name [or make his mark] to the foregoing declaration; and they further swear that they have every reason to believe, from the appearance of the applicant and their acquaintance with him, that he is the identical person he represents himself to be; and they further state that they have no interest in the prosecution of this claim.

(Signatures of witnesses.)

Sworn to and subscribed before me, this

day of

186-; and I hereby certify that I have no interest,

direct or indirect, in the prosecution of this claim.

(Signature of judge or other officer.)

Applicant's post-office address.

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