File:UBC-pension-questionairre.jpg
Pension questionnaire for Uzziel B. Church. Transcription made on 3 Apr 2012 by Richard Brady Williams.
Transcription
3-402.
Certificate No. 192077
Name Uzziel B. Church
Department of the Interior,
Bureau of Pensions,
Washington, D. C., January 15, 1898.
SIR:
In forwarding to the pension agent the executed voucher for your next quarterly payment please favor me by returning this circular to him with replies to the questions enumerated below.
Very respectfully,
J. D. Leighty, U. S. Pension Agent, Indianatpolis, In [NB: This line stamped]
Clark Centre, Clark Co., Illinois [NB: this line hand-written underneath the stamp]
Mclay Grant, Commissioner.
First. Are you married? If so, please state your wife's full name and her maiden name.
Answer. yes Pheba A. Overman
Second. When, where, and by whom were you married?
Answer. at Pery Ralls Co. MO. by Wm. J. Clayton
Third. What record of marriage exists?
Answer. recorded on March 20 [26?], 1867, by Wm. J. Clayton, minister
Fourth. Were you previously married? If so, please state the name of your former wife and the date and place of her death or divorce.
Answer. No
Fifth. Have you any children living? If so, please state their names and the dates of their birth.
Answer. John W. Church April 6th, 1868. dead
Maggie Church August 23rd 1873 Frank Church, Jan 8 1870
Mattie Church April 28, 1875 Etta Church = Feb. 7th 1878
Cora Church Nov. 28, 1880 Goldie Church, Feb. 13? 1885
Mary Church Decem. 1st 1892.
Uzziel B. Church (Signature.)
Date of reply, May 4, 1898
0-8 5301b750m1-98
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