IA II

fctm e Decaraagn % De maais tatle OGcer..
{"newspaper_name": "Delaware patriot & American watchman.", "edition": "01", "page": "p2", "byline": ""}
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1e'm q u Dec n!H'9on 20 Oe maae ty tHe GfceTS.


For the purpose of obtaining the benl fits Of an act en-
titled An act for the relief Of certain SUI yyng officers
and soldiers of the Army Of the Revolution approved on
the 18th Of May, i8Sa , of ----- in the county of
--- in the State Of - do, hereby declare that was
an officer IN the Continental Line of the Army Of the Rev
oluon and served suc There insert the end Of the
war, or Gas the case may be) 10 The time when the ar
rangement OF the Army provided by the resolves Of Con
gress Ut 81 and 2lst of October, $780, was carried into
effect, and was reduced under that arrangement Tat which
period was ---- IN the regiment Of the line


And also declare, that afterwards received certificate
commonly called communication certifcaie0 for A snm
equal to the amount OF five years full pays which sum was
offered by The resolve Of Congress- Of the 22d OF March
1898, instead of the half pay for life to which was enti
tied, under the resolve of the 21s Of October 1880


And do further declare, that have received Of hc
uneu States as pensoner since the Sd day of March
1890 Here insert, No money! (as the case NAV be Ina,
nave received. as pensoner Of the United States
to me by the agent for paying pensions in the State Of
-. "
[Sgned


Before me, --, here insert Justice of the Peace or
other Magistrate, duty empowered to administer oahs in
the county OF ----, in the State of -- personally an
@ pearea, ,ms aay, - and - of the sad county, who
au' seVeraiy, make oath, that -, by whom the t,rero
ing declaration was subscribed is generally repued and
believed 10 have been officer in The Army Of ,he Revn
lutlnn, in manner as therein stated


Witness my hand, this - day Of, in the year -
| [Signed]


a'ac "' - 40 hereby certify, that -, before whom
inc foregoing attdavlts sworn was at the time


luetc insert Justice OF the Peace, or other Magistrate
TO administer oaths - empowered


In testimony Whereof have hereuoto set nv hand
- - ana athxed the seal Of the sad Couc, 4s Js,
os ---, in the year


fSgned