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{"newspaper_name": "Delaware patriot & American watchman.", "edition": "01", "page": "p1", "byline": ""}
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Form of Declaration 10 6s made 5y he OEce,s.


For the purpose Of obtaining the benefits OF act
titled An act for the relief If certain surviving officers
and soldiers of the Army Of the Revoiuon approved
the 18th of May, 1925, |. , of -, in the county of
-, in the State of , do, hereby declare that was
an officer in the Continental Line pf the Army as the Eey