File:UBC-declaration-for-pension.jpg

Declaration for pension for Uzziel B. Church. Transcribed on 3 Apr 2012 by Richard Brady Williams.

Transcription

ACT OF May 11, 1912. 3-014.

DECLARATION FOR PENSION.

THE PENSION CERTIFICATE SHOULD NOT BE FORWARDED WITH THE APPLICATION>

State of Illinois, County of Clark, ss:

On this 20th day of May, A. D. one thousand nine hundred and twelve, personally appeared before me, a County Clerk within and for the county and State aforesaid, Uzziel B. Church who, being duly sworn according to law, declares that he is 74 years of age, and a resident of Auburn Tp., coutny of Clark, State of Illinois; and that he is the identical person who was ENROLLED at Terre haute Indiana, under the name of Uzziel B, Church, on the 17th day of April, 1861, as a private, in Co. D. 11th Ind. [illegible] in the service of the United States, in the Civil war, and was HONORABLY DISCHARGED at Terre haute Ind, on the [blank] day of during or near Aug, 1861. That he also served in Co. I, 16th Ind [illegible], Enlisting therein July 10th 1862 and discharged therefrom at New Orleans La. June 30th 1865. That he was not employed in the military or naval service of the United States otherwise than as stated above. That his personal description at enlistment was as follows: Height, [blank] feet [blank] inches; complexion, [blank]; color of eyes, [blank]; color of hair, [blank]; that his occupation was a farmer; that he was born Dec. 23rd, 1837, at Greenfield, Ind.

That his several places of residence since leaving the service have been as follows: Sugar Creek Tp. Vigo Co Ind. Ralls Co, MO, 9 years; and Clark Co. Ill for the last past 30 years.

That he is a pensioner under certificate No. 192077. The he has [blank] applied for pension under original No. [blank].

That he makes this declaration for the purpose of being placed on the pension roll of the United States under the provisions of the act of May 11, 1912.

That his post office address is R. R. No 7 Martinsville, county of Clark, State of Illinois.

Attest: (1) Cary Mari[illegible] (2) Jacob Fraker

Uzziel B. Church (Claimant's signature in full.)

SUBSCRIBED and sworn to before me this 20th day of May, A. D. 1912 and I hereby certify that the contents of the above declaration were fully made known and explained to the applicant before swearing, including the words [blank], erased, and the words [blank], added; and that I have no interest, direct or indirect, in the prosecution of this claim.

W. I. Martin Jr. (Signature.) (illegible) (Official character.)

[NB: there are two stamps on the lower portion, one reads "Validity accepted as to execution S. (illegible) Chief, Law (illegible)." The other reads, "U. S. PENSION OFFICE MAY 22 1912."