"

·J·DEOLARATION
"' \ ~ .
OF WIDOW FOR PENSION.
.
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UNDER AOT OF 51sT OONGRESS, APPROVED JUNE 27, 1890,

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.§tate DL'I1"~c' Qi;Ottllt!l Of~, 55 : <. , ~';

ON THIS/J--' ...day OL~:..

..,..", ..; , A, D. one thousand eight hundredaud i1i~ety
? #~.... ..
............. , personally appeared before me, .:..... . ~ db.,d~~
.. ,a .../.'/,p"Z;::t
..~....
c:t!~.:~ /J~ ~.)n ~he State and County aforesaid, .:':J;~~'1:~(&.f#~~r~;~·~
,
a'~esident of.))"",,".~,o_ ...,.", ..,.., in the County Of.~[~.:, in the State of..~." ..

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who, being by me first duly sworn according to law, deposes and says:
. My ag now

who ',served under the name OL..... ~~~.:

!it):. Y'''''' I arn the widow
of~S~d(~.«c
.. ~~~~.d.~4, ,,,: ..@~~
'·';iri.~)2).".com.pa~; of tlie.... ".,<lfL:l:egiment oL"~.'., ,..,.,' , , ,.., y, .. vols., '
...., . (In whn.t State and branch of service.) . '~ ...--~--,"-

....day of

'/
sixteen iears of age, viz :
' ..t1?fp~L~~~of sqldier byvt-~.4.t>/""" :,bornth~%'¥ 18 or/} p.o'"
. ,....tf'tjt,e.,I>.:~ct?2r.of soldier by: 4/.".. born .. ~t!', /g r- · 183"2.,. .
~,';j~l£J'.f.!~fl..~ .of soldier by ,..I.............." born ~~ d.. £.i.
, That jn~~!.l~Utionto the children nameclwho are under sixteen years of age, the soldier also left surviving him'
\j;~~folluwing."v,ho are at this tim'e insane, IdIotic, Or other wise-pefti'tftil-'llt,ly helpleR§ : .
") .
; .::. .

.of soldier by ... . ..., born ............................

~....
18
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That I a~ Wit~Ol~~·~~~~l':~~~~~f' s ~PPOl:t than 1~;·~~i;;I~~~I·,· ..::: :~.:~~T
:.. ~d.~
.................................................................................
: ~ ~~::=.,: : L:..

~,~f~~cnrf(,r-ptJi1Si'iTh.a?:-J. /~.I'XV(~, ~ .~C/ .• ',.

. iJ:'hat~ have. heretofore applied for p,en,siol1"OlaimNo. . · .which . fi4 . r/ln.--id:"-'~7<? '
i .', .' 0 • • ~ :'. _. "''''':(8tate WhG.the~
pGll(lillgol'l~?f.cted.), ."
., '.. r:):'lllSdeclaration IS madeby me ror the purpose of obtaining pension under the Act provided bv the .t:.>lstCongress
of the UnitedStates for the widow of a soldier who served ninety days during last war, approved June27, 1890, and
I do hereby appoint, with fl1~1power of substitution and revocation,

T. W. TALLMADGE, 'OF WASHINGTON, D. C.

l~ly rue and lawful attorney to prosecute this claim for pension, who is to be. paida fee of $10 when Pension Certificate .

.,h,ll~;U:~:::,:ffi,:~::,o:,con~"'U~L''P?;vPZ &tt az~

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. ?Sig~tlii,e. of claimaut.) '. .:
I
('1'w 0 witnesses who can write sign ~
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 persons whom I certify to be respectable and entitled to.credit, and, who, being by me duly sworn, say that they were

....•ii"p~:e~;n.:,~nd saw;;,·4~e.r;/:;··~cIkdLe4:(rA
.. " .,,:.'* fiQre.g0i~gdeclarabion,
....:..bh~~rk)
tllartthey. have every reason to believe, from the appearance of said claimant and their acquaintance

with her, that she is the identical person she "p""nteh""lf to be, and that t:'~ xb' to tile

prosecution

=cilL".c4 ~.....-'lO
(If afftauts sign by mark two persons who can write sign Irere.)
~4~i
Sworn to and subscribed before me this .... /.~.~ ...............c1ayOL~~~A. D. 1890, and
I hereby certify that the -ceutents of the above declaration, &(}., were fully made known, read, and explained to the'
'applicant. and witnesses before swearing, including the words. ......emsed.,·
......addec1; and that I have no interest,
.~ ,c1il~e':'ct'~{:'il1direct,
in the prosecution of this claim.

BE EX.ECU·TED BEFORE A CLERK OF THE COURT, A NOTARY: PUBLIC, OR OTH;ER OFFICER AUTHORIZED TO ADMINISTER
'·OATHS FOR GENERAL PURPOSES .• IF BEFORE A JUSTICE Of THE PEACE OR OTHER OFFICER WHO DOES NOT USE AN
OF.FICIAL SEAL, IT WILL BE NECESSARY TO OBTAIN THE CERTIFICATE OF THE CLERK OF THE COUNTY COURT AS TO
HIS OFFICIAL CHARACTER AND GENUINENESS OF HIS SIGNATURE. IF EXECUTED BEFORE A NOTARY PUBLIC WITH A
SEAL, NO OTHER CERTIFICATE IS REQUIRED.

., 55:
••.•.•.•.•... ~ ....•••••••••• c••....•..••••.••.••....................•.••. , before whom the ab0ye:
and. f0r .
said' county, duly-authorized to administer oaths for general purpos.es, and his signature thereto is genuine.'

Witness my .hand andofficial seal this

..... ,

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