rC 7

Form II q Pe.gar of .qk,orner.
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Form ef a Po.gsr Of .7,tornes.
Know all men bN tt'c p*,SG ,tlat l. -, ct -, IN
the county of ----- the s. - do hereby consti-
uic and appoint my 'iue dfId lawful attorney with
power of substitution for me, and iny name, 10 receive
from the United States the amount of pay due me,
under the act TO Il ,eef uf certain surviving officers i
soldiers of the Reyout approved 18th May 1896,
in the - regiment CT the = line OF the army OF
the Revolution.


Witness my hand and seal this - day Of -. in the
wear


Sealed aud dehrcfed in the2


tresence a.. S


[Sgnedl L. 81
Before me, -, Justice OF the Peace in the county Of
- in the Slate Of -, personally appeared, This day
-, whose is subscribed to the foregoing power u
attorney, and acknowledged the to be bis act and
deed.
Witness my hand this day Of - in the year -
[Signed


L., Clerk Of the Court Of the County of -, in III,
Safe Of -, do hereby certify that -, before whom
be foregoing power of attorney acknowledged, is
Justice ui the Peace.


In estmony whereof have hereunto set nv hand
t and affixed the seal u the said court, this


day -, in the year.