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C'ttH n/y -j/\ < Jll I Ill's .
/y /.	.....i
ys?s ?
personally appeared before mo, ... within and for tIk; cand Slati
, A. ]). one n^iUj^^Td eight hundred aiu^ciglity->r >,e
?2
(.-(xirt. <>l I?l?i
Ul ,	,.	..., ?,	??	;	f...	years,
1 ".....................................?n.lv or ...	^<2/Cs
? i i
lucllliral ..
county of...
, who, Ik-Iu^ duly sworn according to law, declares that lu: is (he
duv
^	-	>-- - .	.. -/	o x'?:...., who. iK'iujr (111
s'	^	S 'r/	f~\	\
., who m?jw ENROLLED on tkn...................... ^ ... cav
of.................^y^.... ....,	company	.........ofUie	regiment	of	____~
commanded by .?&'	..........................................................and was honorably DISCHARGED at
...^'.4^>....... on the -/=............ day of	..., 18^^T!i:it liis
persona! description is a.s follows: Ai;c,	years;	height,	.?$7	inches;	complexion,	)
hair,	tZ'Zy	....; eyes,_____That while a member of the organization aforesaid, in the service
and in the linn of his'duty	..., in the State of
18 &<Jhe . /^'	rt-fcPsr	^O.
(Iloro ulnlo niiiuo or tmlnrn of	m*	ih?	l...uiitu?
^ sf	jr~S	/	*	{Iloro	Htnlo	niuno	or nulurn i>(	nr'ilm l.tiuiii
kK>,	y	iIh cuiih*?k^Ir l?y wimiitt nr iniiiiy, l*liiv'7M'(?*,U?i muinit'rn ^ which rc***< Ivoil.)	*	^
? -, .	^	v-"......-'.......
y- .................??"'?</ ? ^ ^
C.{J 'tv ..A?t'j
'or.
'"?J'lial. In; was (realcd in hospitals as follows: ...............................................................................................
(Hum Muli* llio imiiKiH nr niiitilMiir*, Ull'l Iho l?*0ulltlort of ill) h(>?]?ltitlrt ill whlrli lrnuto'1, tho Jalvi of iroatnioiiL
..7^C>......
t '- S Ss S s j-v. ?' '?' /
That he has .. s............... been employ^d^n the wilitnryfuv naval servico otherwise lh an (is stated above ^2^e._	^
, n	t?S	/f	*-7.	*	/	/y	sf j ?	v	(|l,:,'?
a >.< tliur j-ilui ?ir NiiltBL''|iiuiil In l hit t Ml tiled uliovd, ainl {lio iIuIoh it( u)ilth 11 U'imii uimI ninlo'l.)
'i'liaL Miirc lravin^ I Uy^t'wlci) t li is applications resided in tin; . in (he Stale of	his	(Mrujintion	has	been that of a
Thm lUjH,' l" bis enjry into the service above named he>vas a man of good, sound physical health, being when enrolled
a	Thai	ho is now _________________________disabled from obtaining his sulisislcnco by
inamial lal-or by reason of his injuries, abovo described, received in the service of the, United States; and he therefore makes iIn'-, declaration for the punyise of being placed on the Invalid pension-ro^ of die United States. (	^
ii.- i.yrd.y iii>|khjiis ?.//??",'SS- :	>-?/'/.	:j.
?,r	'i'	o'	/^n<-
...., State of .
to prosed:'e his claim. Thqt he has .received
Oj-TICB A - DKK^sis ............................
State of ..? ^^L-yy^S.stLy/
f
his true and lawful attonicv
countv of.
nppliec^ f<jr a pension. That his Post
Claimant?s signature
Attest: ..A S
r,
/ Aos
10A a.	<s/6
?.............(?
. .. *?'? r-
IkL