5

................Country:
.............................................................................................................................Clark of the county court and for the County and
bed, do hereby certify that.............................................................................................................Esq., before whom the foregoing
[activists] were made, and who has thereunto signed his name, was nt at the time of doing, a............................................................
............................... in and for the Country and state above named, duly commisioned and sworn, that all his official acts
such are entitled to full faith and credit, and that his signature thereto is genuine,
IN TESTIMONY WHEREOF, I have hereunto signed my name and affixed my official seal this.............................................................
y of................................., 186....

INSTRUCTIONS.
1. Judge or Clerk of a Court of Record. 2. Applicant's name 3. Name of Soldier. 4. Bank of Soldier. 5. Letter of
Company if known. 6. No. of regiment if known. 7. State from which regiment came, and whetherVolunteer or Mili-
tia. 8. State the time, place and cause of death. 9. Applicant's Name. 8. Name of Soldier.
4. Rank of Soldier.
อ. Letter of
Company if known.
6. No. of Regiment if known. 7. State from which Regiment came, and whether Volunteer or Mili-
8. State the time, place and cause of his death. band be dead, here state it.
9. If widow had married after Soldier's death, and her second hus-
10. Here give Post Oflice address of applicant.
11. Names of witnesses.
" In every case you must sond proof of marriage, either by certitied copy of Marriage Record, it there is one, or if none, you must prove by 2 witnesses that there is no Town or Church Record to be found, and then you must send atiidavit of the Minister or Magistrate who married you.
If he is dead, or removed so that you cannot find him, prove his death or removal
by & witnesses, and then, and not till then will atlidavits of others who were at the marriage be received.
if there be no
lown or Church Record, and Minister or Magistrate be dead, and all the witnesses be dead, or their residence unknown, then prove such facts, and cohabitation can theu be proved.
If parties were married in Europe, and record can't be obtained,
then send sworn copy of record of baptism of children, or, send their passport papers, or such other papers as show they have been treated as Insband and wife.
Always prove, by copy of your Family Record, duly sworn to by 2 witnesses, the names,
and ages, and residence of your children; if no such Record, prove it by & witnesses who remember the time or near the time, and Jact of their birth.
If you cannot prove nil as above, execute the declaration, and write me telling me what you
can prove.
You must swear to this Declaration before some Judge of a Court, or Clerk of such Court. Any Judge of a
Court having a seal will answer.
Judge of Probate Court, Justice of a Criminal Court, " Side Judge," or Justice of Bes-
sions will answer.
In every alidavit the witnesses must swear that they have no interest in the chim, and the magistrate
must certify that he has to interest, direct or indirect, in the claim
CLAIM TOR
WIDOW'S PENSION
Act of lith July, 1868.
Mrs. Mary and Angle
Widow of GeorgeW Jo
Co []. [] Reg's [] Vols
.......................................
sus Sept 26562

Fodarded to Wm. Van Marter, by A Namugle
R. Hamington
of [Synus]
[signature]

WM. VAN MARTER, Au's,
PIERESE