State of the balance of said pension from the day of 18-, to the day of, being the day of his death. Witness my hand and seal, this Sealed and delivered in the presence of day of 18-. day of - A. D. 18-, before the undersigned de authority within and for said county, personally came [widow, or child, or executor, or administrator] of ceased, and acknowledged the signing and sealing of the foregoing power of attorney, for the purposes therein expressed. Given under my hand, the day and year aforesaid. [J. P.] The official character of the magistrate or other officer taking the acknowledgment, must be certified by the clerk of the proper court under its seal, as in other cases. Certificate of the Court as to the Death of a Pensioner. and for do hereby certify, that satisfactory evidence has been exhibited to said court that United States, at the rate of dent of the county of on the was a pensioner of the dollars per ; was a resi in the State of ; that he left a in the year widow [or no widow, or child, or children, as the case may be] whose name is or are, as the case may be [L. 8.] this In testimony whereof, I have hereunto set my hand and RENEWAL OF PENSIONS. Declaration for Renewal. [Military Case.] day of record within and for said county, personally appeared a resident of said county, aged years, who being first duly Bworn according to law, doth, on her oath, make the following declaration in order to obtain the benefits of the act of -, renewing half-pay to certain widows and orphans. That she is the widow of who was a ——, in company commanded by Captain in the - regiment of manded by Colonel , in the war with ; for proof of which she refers to the paper on file in her original application, upon which she formerly obtained a pension at the rate of dollars per month, payable at the agency for paying pensions in com in the State of ; the certificate of which pension has been surrendered. She now claims the benefits of the act of ---- and asks that her name may be placed upon the list of pen sioners payable at the agency in in the State of She further deciares that she is still a widow. [Signature of Claimant.] Sworn to and subscribed in open court [or before me udge, or clerk of said court of -], the day and year aforesaid. And I certify that I believe [or know] the declarant to be the person she represents herself to be, and that I am not interested in her said claim. [L 3.] In testimony whereof I hereto set my hand and affix the seal of said court, this day of, A. D. 18—. [Clerk's Signature.] If sworn to before a judge, his official character must be certifed by the clerk, under the seal of the court. STATE OF County of On this fore the the and 88. day of -A. D. 18-, personally appeared becourt [or before me judge, or clerk, of court], a court of record in and for said county, who are [to me well known to be] residents of the county of ——, and credible witnesses, and who being first duly sworn, depose and say, that they are well acquainted with Mrs. who subscribed and made oath to the above declaration in their presence, and have known her for at least — years last past; that she is the widow of ——, who served in the manner specified in said declaration; that she is the identical person to whom a pension was granted for such service, at the rate of dollars per month, and that she is still a widow. [Certificate of Oath.] [Signature.] Declaration for Renewal. [Naval Case.] TO THE COMMISSIONER OF PENSIONS: The memorial of the undersigned, the widow of the latein the navy of the United States, respectfully who was a shows: That her husband, the aforesaid entered the service of the United States in the year -; that while in the said service and holding the rank above mentioned, he departed this life at on the day of —, in the year -; that the under signed was married to the said on the day of —, in the year and in proof thereof, she refers to papers on file in the Pension Office, upon which she obtained a pension for five years. She therefore claims the benefits of the act of Congress of the granting pensions to the widows of officers, seamen and marines, who have died in the service aforesaid; and she requests that her name may be inscribed on the roll of pensions under that law, who are paid at --, in the State of [Claimant's Signature.] Here must follow a certificate of the judge or clerk, as in the case of a widow whose husband was in the military service. The same proof as in the last-mentioned case must accompany the declaration, and a power of attorney must also be executed in such cases. INCREASE OF PENSIONS. No application for an increase of an invalid pension wil be examined, unless the proof be first presented to the Pension Agent, where the payment is made. He will forward the "Surgeon's Affidavit," the "Pension Certificate," etc., to the Depart ment of the Interior. If the applicant was pensioned on account of a wound reeived previous to the war of 1812, he should be examined by two surgeons, under a commission issued by a judge of one of the United States courts, in order to cbtain an increase of his pensic n. The magistrate who may administer the oath to the surgeons must certify that they are respectable in their professions, or be lieves, on the information of others, that they are so. And the official character of the magistrate must be certified by a proper officer under his seal of office. If the claimant be within thirty miles of an army surgeon, he nuss obtain his testimony. STATE OF On this Application for Increase. [Army Case.] 88. day of, A. D. 18—, before me, a within and for said county, personally appeared dent of said county, aged 8 resi years, who, being by me first duly sworn, declares that he is the same person in whose favor a certificate of pension was issued on the 18-, by the Secretary of the Interior, at the rate of month, from the day of day of per 18-; and which pension day of 18-; at the That the disability allowed was caused by in company in the war with in the and was graduated has been paid to him to the agency of in the State of for which the said pension was in the line of his duty as a regiment of for [state the degree of disability for which the said pension was allowed, as: one-fourth, one-half, or otherwise] disability from manual labor. That said disability has since increased [here give the nature and effect of the increase] and renders him less able than formerly to perform manual labor, as will appear by the surgeon's affidavit herewith filed. He makes this declaration for the purpose of obtaining an increase of his pension, corresponding with the increase of his disability as aforesaid. Claimant's Signature.] Sworn to and subscribed before me, the day and year afore said; and I certify that I have no interest whatever in the foregoing claim. [Officer's Signature.] of Captain who, it appears by the accompanying pension certificate, was placed on the pension roll at the rate of dollars per month, on account, as he states, of having received a [here give a particular description of the wound, injury, or disease, and specify in what manner it has affected the applicant so as to produce disability in the legree st1 ted; and show its origin and progress], while in the line of duty, anc in the said service, on or about the day of —, in the year at a place called in the State of is not only still disabled in consequence of the said injury, but in the opinion of the undersigned, is entitled to [one-fourth, one-half. or, as the case may be], more than he already receives as a pensioner, being disabled to a degree amounting to [this must be fillea up with the degree of disability, as one-fourth, one-third, one-half, three-fourths] a total disability. [Signatures of two Surgeons.] and Sworn to and subscribed before me, the day and year afore said; and I certify that I am acquainted with and know them to be respectable surgeons, in good standing in their profession; and that I have no interest whatever in the above claim. [Officer's Signature.] To these must be appended the certificate of the clerk of the proper court, under its seal, as to the official character of the magistrate administering the oaths. Application for Increase of Navy Invalid Pensions. STATE OF } 88. day of 18-, before me, a resident of a per who being duly On this sonally appeared sworn, declareth that he is the same person in whose favor a certificate of pension was issued on the day of, 18—, under the signature and seal of the Secretary of the Interior, at the rate of cents per month, from the —, 18-, and which pension has been paid him to day of 18, inclusive, at the Navy Pension day of the Agency. dollars That the disability for which the said pension was allowed was caused by in the line of his duty while attached to the United States [here insert class or name of vessel], and holding the rank of in the year 18-, and was graduated for [state degree of disability mentioned in certificate] disability from manual labor; but that such disability having increased, the said for the purpose of obtaining a corresponding increase of his pension, requests that a Board of Survey may be ordered immediately in his case, to be held at the United States Naval Station at [Claimant's Signature] |