suRcEoS's AFFIDAVIT.
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(Daie.) IT ss HEREBY CERTIFIED, That---a -in the enmpany---in the---re- Riment of the United Siaies--is rendered inrapahle of performing the duty of sold Ter, hy reason of wounds or other inJuries inflicted while he was actually in the seEslee aforesaid, and in the line of hts duty, viz: By satisfactory evidence and accurate ex- animation, it appears that m the---tlay oE---in the year engaged-- --as or near place cailesl--ln the district or territory of--he Eeceived-- --in hiss

 and he is thereby m, only inexperienced ios military dniy, but, in the opinion Of the un- dersigned, ist---disabled from cbaain- ing Ris subsistence from manual Isbcr.--

 Surgeon. S9rgeoR.