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DECLARATION, in ordsr to oStaia the benek, of fthe taird sec- tion cf iae aet ef Congress of the 4ih Ju- V, 1896.

 SrATE TERRITORY, oR DISTRICT

 of

 OS this--day of------, personally appeared before the----of he, A. E. resident of----, Tn the county of---and State, Territory, or District of----, aged --years, who being first duly sworn ac- cording to law, doth, ca her oath make the following declaration, in order 10 obtain the benefi. of the provision made by the act oI Congress, passed July 1, 1896: That she is the widow of---. who was here inser the rank the husband held in the army, navy os militia, as lhe case may be, and specify tue service performed, as directed in rul' namber four of these regulations.