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0613

APPLICATION OF DISCHARGED SOLDIER FOR ARREARS OF PAY, &c.
State of }ss:
County of }

On this _ day of _ 186_, personally appeared before me, a _ in and for the County and State aforesaid, _  of _, in the County of _ and State of _ who, being duly sworn according to law, declares that his age is _ years; that he is a resident of _, County of _, State of _, and that he is the identical _ who was a _ in Company _ of the _ Regiment of _ Volunteers, and who was discharged from the service of the United States at _, on the _ day of _, 186_, by reason of _, and that there is pay due him for services as aforesaid from the _ day of _, 186_, to the _ day of _ , 186_, and also _
That his discharge is _ 
and he desires all communications concerning this claim, and the certificate for pay, to be sent to him at _, County of _ and State of _ .
Signature of Claimant:
Also personally appeared before me, _ and _ , of the County of _ and State of _, who, being duly sworn according to law, declare that they have been for _ years acquainted with _ , the above-named applicant, who was a _ in Company _ of the _ Regiment of _ Volunteers, and know him to be the identical person named in the foregoing declaration; and that they have no interest whatever in this application. 
Signatures of Witnesses:{
Sworn to and subscribed before me, this _ day of _, 186_.
Official Signature:
I certify, That _ ,before whom the foregoing declaration and affidavit were made, is a _ duly authorized to administer oaths, and that the above is his signature.
In witness whereof, I have hereunto set my hand and official seal, this _ day of _, 186_.
[L.S.]                          Clerk of the

NOTE.- In all cases where a mark is substituted for the written signature, two disinterested witnesses are required. 
*If anything other than pay proper be claimed, such as clothing, &c., state here fully the nature of the claim and the period when incurred.

Transcription Notes:
---------- Reopened for Editing 2023-09-21 07:09:39 ---------- Reopened for Editing 2023-09-21 09:23:38