Balaam Bolin, Declaration for the Increase of an Invalid Pension, 1889

TEXT:

Declaration for the Increase of an Invalid Pension.

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State of Indiana, County of Morgan, ss:

ON THIS 16 day of March A. D., 1889, personally appeared before me a clk ct court in and for the County and State aforesaid, Balin Bolin aged 60 years, a resident of the County of Morgan, State of Indiana, who, being duly sworn according to law, declares that he is a pensioner of the United States, enrolled at the Indianapolis Pension Agency at the rate of 10 dollars per month, Certificate No. 267380, by reason of disability from Chronic Diarrhea resulting rectal Disease of rectum incurred while serving as a Private in Company B 67 Regiment of Indiana Volunteers. That he believes himself to be entitled to an increase of pension on account of the increase of disability for which pension was granted. He claims on Heart disease result of Diarrhea[;] that he hereby appoints with full power of substitution and revocation, J. J. JOHNSON, MARTINSVILLE, IND., his true and lawful attorney, to prosecute his claim. His Post Office address is Martinsville Morgan County Indiana

(Signature of Claimant.) Balaam Bolin

[witnesses section blank and crossed out]

Sworn to and subscribed before me this 16 day of March A. D. 1889, and I hereby certify that the contents of the above declaration, &c., were fully made known and explained to the applicant ["and witnesses" lined out] before swearing, including the words ---- erased, and the words ---- added; and that I have no interest, direct or indirect, in the prosecution of this claim.

David Wilson

Clk.

The officer before whom this declaration is executed, must be sure to note in his certificate, all Erasures and Interlineation as indicated above.

NOTE-- This should be sworn to before a CLERK OF COURT, NOTARY PUBLIC, or JUSTICE OF THE PEACE. If before a JUSTICE or NOTARY, then CLERK OF THE COUNTY COURT must certify to his official character, UNLESS SUCH CERTIFICATE IS ALREADY ON FILE in the Pension Office, WHEN THAT FACT SHOULD BE STATED.