B. Form of Declaration for obtaining a Widow's Navy Pension. State (Territory, or District) of County of On this peared before me, trict of) 88. day of A. D. -, personally ap of the in the county of -, aged A B, a resident of and State (Territory, or Disyears, who, being first duly sworn according to law, doth on her oath make the following declaration, in order to obtain the benefits of the provision made by the act of Congress approved July 14th, 1862, granting pensions: That she is the widow of who was a [here state decedent's service], who [here specify the time, place, and cause of death]. She further declares that she was married to the said on the day of in the year; that her husband, the aforesaid died on the day above mentioned, and that she has remained a widow ever since that period [or if she has remarried, and again become a widow, the fact must be stated], as will more fully appear by reference to the proof hereto annexed. The personal description of the said her deceased husband, is as follows: [here state his age, height, complexion, occupation, &c.] She also declares that she has not in any manner been engaged in, or aided or abetted, the rebellion in the United States. (Declarant's signature.) 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 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 her self 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 interest, 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 Navy Pension. peared before me of the , -, personally ap A B, a resident of and State (Territory, or Dis in the county of trict) of -, aged years, who, being first duly sworn according to law, doth on oath make the following declaration, as guardian of the minor child of -, deceased, 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 and seamen; that he is the guardian of [nam ing the minor child or children, his ward or wards], whose [here state decedent's service]; and that father was a the said died at in the year on the day of [here state the cause of death]; that the mother of the child- aforesaid died [or, again married, be ing now the wife of ; the year -], on the day of in and that the date of birth of his said He further declares that the parents of his said ward— were married at year on the by day of, in the (Guardian's signature.) 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 Mother's Application for Navy Pension. State (Territory, or District) of On this day of peared before the -, in the county of District) of -, aged of the personally ap A B, a resident of 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, granting pensions: that she is the widow of and mother of who was a [here state decedent's service, and personal description], 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 of age 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 2d 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 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 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. (Signatures 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.) Applicant's post-office address. E. Form of Declaration of Orphan Sisters for Navy Pension. State (Territory, or District) of County of On this day of peared before the in the county of District) of } 88. of the A B, a resident.of and State (Territory, or 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 guardian 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 sister- of and who was a [here state decedent's service and personal description], 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 proper department, to establish her (or their) claim under the law above named. He further declares that his said ward, the receipt of any pension under said act. is not in (Guardian's signature.) 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. 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. |