^ **s Class IJB373 BookiL Author Title Imprint. Isca Ift— 47372-1 O^o INSTRUCTIONS AND FORMS TO BE OBSERVED BY PERSONS APPLYING TO THE PENSION OFFICE FOR INVALID PENSIONS, BY REASON OF DISABILITY INCURRED IN THE MILITARY SERVICE OF THE UNITED STATES. WASHINGTON: GOVERNMENT PRINTING OFFICE, 1862. yK J. or a ^, > INVALID PENSIONS. All persons applying for pensions, by reason of dis- ability incurred in the line of duty while in the military service of the United States, must make a declaration, under oath, (or affirmation,) before some court of record, setting forth the age and residence of the claimant ', the service in which he was engaged ; the time, place, and manner of incurring the disability alleged, with its precise character ; and the date of his discharge ; together with a statement of his resi- dence and occupation since leaving the service. In support of the averments of such declaration, the following rules must be observed in presenting the testimony : I. The claimant's identity must be proved by two witnesses, certified by a judicial officer to be respect- able and credible, who are present and witness the signature of the declaration, and who state, upon oath, (or affirmation,) their belief, either from personal acquaintance or for other reasons given, that he ia the identical person he represents himself to be. ' 11. The applicant must, if in his power, produce the certificate of the captain, or of some other com- missioned officer, under whom he served, distinctly stating the time and place of the said applicant's having been wounded, or otherwise disabled, and the nature of the disability ; and that the said disability arose while he was in the service of the United States, and in the line of his duty. III. If it be impracticable to obtain such certificate, by reason of death or removal of said officers, it must be so stated in the declaration of the applicant, and his averment of the fact proved by persons of known respectability, who must state particularly all the knowledge they may possess in relation to such death or removal. Then secondary evidence can be received. In such case the applicant must produce the testimony of at least two credible witnesses, (who were in a condition to know the facts about which they -testify, ) whose good character must be vouched for i)y a judi- cial officer, or by some one known to the Department. These witnesses must give a minute narrative of the facts in relation to the matter, and must show how they obtained a knowledge of the facts to which they testify. lY. The surgeon's certificate of discharge should show the character and degree of the claimant' s disa- bility, but when that is wanting, and when the certifi- cate of an army surgeon is not obtainable, the certifi- cate of two respectable civil surgeons will be received, in accordance with the form on page 8. These sur- geons must give, in their certificate, a particular description of the Avound, injury, or disease, and specify how and in Avhat manner his present condition and disability are connected therewith. The degree of disability must also be stated. Y. The habits of the applicant, and his occupation, since he left the service, must be shown by at least two credible witnesses. YI. All evidence should be verified by oath, before a judge of the United States court, or some judge or justice of the peace, or other officer of a State, having authority to administer oaths for general purposes ; and, if verified before an officer of any State, his official character must be duly authenticated ; and such officer must, in all cases, certify that he is not interested in the prosecution of the claim. YII. Attorneys for claimants must, in all cases, have proper authority form those in whose behalf they ap- pear. Powers of attorney must be signed in the presence of two witnesses, and acknowledged before a duly qualified officer, whose official character must be properly shown. JOSEPH H. B4RRETT, Commissioner, FORM OF APPLICATION FOR AN INVALID PENSION. State of i County of ) On this of , A. D. one thousand eight hundred and , personally appeared before me, a judge of \liere state the official character of the per- son administering the oath,~\ within and for the county and State aforesaid, aged years, a resident of , in the State of , who, being duly sworn according to law, declares that he is the identi- cal , who enlisted in the service of the United States as a in the company commanded by , in the [Aere describe what ivar^ or other service declarant ivas engaged ^?^,] and was honorably discharged on the day of , in the year ; that, while in the service aforesaid, and in the line of his duty, he received the following wound, (or other disahility^ as the case may he. ) [Here give a par- ticular and minute account of the ivound or other injury, and state how, when, and lohere it occurred, luhere the applicant has resided since leaving the service, and what has been his occupation.^ (Signature of claimant.) Also personally appeared ■ and , resi- dents of the (county, city, or toiun,) persons whom I certify to be respectable and entitled to credit, and who, being by me duly sworn, say that they were present and saw sign his name (or make his mark) to the foregoing declaration ; and they further swear, that they have every reason to believe, from the appearance of the applicant and their acc[uaiiitance with him, that he is the identical person he rep- resents himself to be, and that they (deponents) do reside in the (county, city, or town,) aforesaid.) (Signatures of witnesses.) Sworn to and subscribed before me, this day of . (Signature of judge or other officer.) [In case the applicant does not live within thirty miles of a surgeon of the regular army, the following- will be required instead of the certificate of such surgeon :] surgeons' affidavit. (Date.) It is hereby certified, that , a in the company of , in the regiment of the United States , is rendered incapable of per- forming the dut}" of a soldier, by reason of wounds or other injuries inflicted while he was actually in the service aforesaid, and in the line of his duty, viz : By satisfactory evidence and accurate examination, it appears that on the day of , in the year , . being engaged at or near a place called • , in the (Staie, District, or Territory) of — , he received in his^ and he is thereby not only incapacitated for military duty, but, in the opinion of the undersigned, ist disabled from obtaining his subsistence from manual labor. , Surgeon. . Surgeon. *Here give a particular description of the wound, injury, or disease, and specify in what manner it has affected the applicant so as to pro duce disability in the degree stated. -j-Tlie blank in the last line but one is to be filled up with the propor- tional " degree" of disability ; for example : " three-fourths," " one- lialf," "one-third," &c.,or "totally," as the case may be. g^ The magistrate who may administer the oatli to the surgeons must certify that they are reputable in their profession, and the official character and signature of the magistrate must be certified by the proper officer, under his seal of office. g^ Mode of autheniicatmg papers. — In every instance where the certifi- cate of the certifying officer who authenticates the papers is not written on the same sheet of paper which contains the affidavit, or other paper authenticated, the certificate must be attached thereto by a piece of tape or small ribbon, tlie ends of which must pass under the seal of office of the certifying officer, so as to prevent any paper from being improperly attached to the certificate.