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[[stamp]] THE NATIONAL ARCHIVES OF THE UNITED STATES [[/stamp]] Received of Capt. W W Deane A.A.G. May 1866 the following blank forms viz Ten (10) "Declaration for Invalid Pension" Three (3) "Application for Prize Money" and Three (3) "Power of Attorney" and Ten (10) "Declaration for Minor Children's Pension" H.C. Strong 1s Lt Actg ASA Com'r