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Application for Pension
How Made; What to Contain; Description of Disabilities; Oath Prescribed Form No. 3c General Prorate Class
Application of Indigent Servant of a Soldier or Sailor of the Late Confederacy, under Chapter 102, Code of 1906, as amended by Laws of April 5th, 1910, Chapter 207, and Laws of March 24th, 1916, Chapter 199, and Laws of March 27th, 1918, Chapter 131, S. B. 47, II. B. 347 and Ii. B. 987 Laws of 1920.
Applications must be filed in duplicate with the Chancery Clerk on or before the first Monday in September of the year in which application is first made, and no application will be entertained not on the printed form. (Applicant must make answer to all of the^|ollowing Questions.)
Q. What is your name ? Answer..
Q. .What is	your age? Answer........ .......25
?Q.	Are you	a bona fide resident of the State of Mississippi? Answer.
Q. How long have you been a bona fide resident of Mississippi? Answer.^....?^7?'..................
Q. In whjit county do you reside ? Answer............................................... f..........................
Q. .	What is	the siamp.5>f,,s?oijir' pQ$toffice ?, Answer..................................................,....
Q.	In what	county do you?reside now? Answer............................................................../....
1 y ..	??3	^
Q. In what county'did you reside last year and the year before? Answer.........................
? l................................................../JrA sir............................................
Q. Did you draw a pension from the State of Mississippi last year ? If so, from what county ? Answer..
Q. Did you draw a pension last year from any other State or county? Answer.............................................
Q. Are you now, or have you been within the last three years, an inmate of the Soldiers Home at Beauvoir?
Answer........................................................................................v................
If so, when and how long were you an inmate there?.................................................................
Q. In what State did you reside when yoji served as a servant of a soldier or sailor in the service of the Con-
*	A	*	j
federate States? Answer..
Q. When did you serve in that capacity? Ajiswer.? ti	/.Vo.^	n5".......................
Q. How long did you serve? Answer.....................................................
Q. What was the name of the Confederate soldier or sailor whom kqu served? Answer. ...
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Q. What was the number of the regiment or name of the vessel an which your owner served? Answer
Q. The name of its commander ? Answer........^^y^^^^?^!................................
Q. Letter of desigiiationji^ the company in whicn your owner served? ^Answer...........