Revolutionary War Pension and Bounty Land Warrant Application File S. 4422, for James Irvine, Virginia
Page 1

SERVICE
Va.

Irvine, James

NUMBER
S. 4422

Carded

CONTENTS
Page 2

22136
Kentucky

James Irvine
Adiar Co in the State of Kentucky
who was a private in the com commanded
Captain Rogers of the regt commanded
Col Morgan in the
line for one year & 2 months

Inscribed on the Roll of Kentucky
at the rate of 46 Dollars 66 Cents per annum
to commence on the 4th day of March, 1831.

Certificate of Pension issued the 12 day of Oct
1833 and Upton
Miller Columbia

Arrears to the 4th of Sept.........................116.65
Semi-anl. allowance ending 4 March......23.33
...........................................................................$139.98

{Revolutionary Claim,
Act June 7, 1832.}

Recorded by Danl Boyd Clerk,
Book E Vol. 7 Page 14

Va. Line
Records corrected
Apr. 20, 1904. [Illegible]
Page 3

Adair County Kentucky
This day personally appeared [inserted: the undersigned] before me
a Justice of the Peace for the aforesaid County James
Irvine and made oath in due form of law
that the first tour he served in the service of
the United States was under Capt Rodgers
in his company. Maj Williams and Col.
Haynes Morgan. The service performed on this
tour was at Gevyns Island, and on the 
Powtowmack River, and in the Cherokee Nation or
near there at the Long Island of Holstein
and it was performed with an embodied corps called
into service by competent authority, that he was
in the field and that this toor was seven months
he was not employed in any [illegible] pursuit _
That his second Tour was commenced in the spring
of 1777 at which time he volunteered in the State
service and was employed to assist in collecting
military under the command and direction of
Commissary McCraw, this tour was 4 months
all of which time he was engaged with his waggon
and team for the use of which he never recd one
cent. The service in the foregoing town was performed in
Hallifax & Pittsylvania County Via. that he was
employed in no civil pursuit during the afsd
last mentioned Tour. That his third Tour
was performed as well as he recollects in the
year 1778 or 9 he volunteered under Capt Rogers
His majs name was Durham his Col Mason
Lieutenant Col. Loo. Jones when joined to the
Page 4

Army which was commanded by Gen Lincoln
was in a battle at Stona River in South Carolina
and the service of this Tour last mentioned was
performed in the field in South Carolina and
that he was employed in no civil pursuit
during his service of the afsd last mentioned tour
which was three months. That from the time
he left home until his return was seven months-
That he took charge of a magazine of ammunition
&c by order of Col Boyd in Hallifax
County Via. that his service in this way was
4 months and that he was engaged in a
Civil pursuit during the afsd last mentioned
tour [crossed out, illegible] was the fourth tour
That his next tour was in the summer
1781 which was a tour of 3 months as
volunteer in the Virginia malitia with his
waggon & team under the direction of George
Isbel Waggon Master this service was in the
Counties of Prince Edward Goochland &
Albemarle. that he was engaged in no
Civil pursuit during the afsd last mentioned
Tour. That his next tour was under
Capt. Rodgers joined Stephens brigade of
Malitia and was command a short time
after by Capt Bates Capt Rogers having
returned. That he was waggon master
Page 5

appointed by Col Cole the service was
performed between Jamestown & Williamsburg
and at York at the taking of Cornwallis. that
it was in the field not in garrison and
he was engaged in civil [inserted:] no civil pursuit during
the  afsd last mentioned Tour or any other
Tours He states there he performed more
service but his reccollection is indistinct
about it. Tthat he served
with an embodied corps called
into service by competant authority each & every time.
James Irvine
Sworn to and subscribed
in the presence of me James Irvine
this 19th of September 1833
Daniel Suddarth J P.

State of Kentucky
Adair County ⎬Sct
Sel
I William Caldwell Clerk of the Court
of Adair County certify that Daniel Suddarth is
an acting Justice of the Peace in and for Adair 
County, and that due faith and credit is due
and should be given to all his official acts and
the foregoing signature purporting to be his is
genuine _
In testimony whereof I have
hereunto set my hand and
affixed the seal of my said
Office this 19th day of September
1833 Wm Caldwell Cc & CC
By his Deputy Wm Bloadwell
Page 6

State of Kentucky Adair
County & Circuit } SS
On this 8th day of September 1832 personally appeared
in open Court before the Circuit Court of Adair
being a Court of Record now sitting, James Irvine
resident of the County of Adam aged 76 years
who being first duly sworn according to law doth
on his oath make the following declaration, in order
to obtain the benefit of the act of Congress passed
June 7th 1832
He States that he was born on the
4th day of September in the year 1755 in
the County of Halifax and State of Virginia
that his father had a register of his age which
on his death passed into the hands of his
brother John Irvine of Halifax County Virginia
who died about two years time and
whether the register is in existence or not he
does not know this was only a private
Register kept on a blank leaf of a book
(Back on the New Testament,) He states that
he continued to live on Dan River in the
County and State aforesaid until the month
of May in the year 1776 he entered the
Page 7

Service of the United States as a volunteer
as he thinks in the militia troops of that State
minute man under the command of Capt Rogers, Majr
Williams his Colond Haynes Morgan his [inserted:] Rogers company
& Capt James Turner from the same County &
in the same services held their rendezvous
at Boyds ferry on Dan River from thence
they marched through Charlotte, Lunenberg &
Amelia &c Counties of Virginia joining the
troops from the Counties at various points
on the line of March to Petersburgh there
they received orders to march to Williamsburg
via and from thence to Givinns Island
in Virginia then their regiment was formed
& General Nelson of Virginia was then Brigadier
and commanded them on that occasion Gov
Dunmore was stationed on the Island &
Carrying on a war of plundering the [illegible]
and kidnapping slaves. He states
that the American army threw up a breast
work on the bank of the River South of
[illegible] of the Island & having a few pieces of
artillery they opened them on Dunmores
encampment there was a considerable time
spent in making the breast works & other necessary
arrangements say one month or more after the
works were completed Dunmore was soon
Page 8

dislodged in one day or but little more he
was greatly difficuted to get away owing to
tide being against him & he had to tow
out his shipping by boats and some of
them he could not get away & burnt
at least three of them. this was as well as
he recollects in July 1776 in harvest time
After Dunmores departure the American troops
took possession of the Island and lay there
a short time until they received orders to
March to the mouth of the Potomac to oppose
the landing of Dunmore who had sailed
round, Colo Morgans Regiment marched
across the Country and took its station at
a place on the Potomac called the Cherry [inserted:] Point
He states that he with his regiment remained
there a short time Dunmore being 
unable to effect a landing moved off
after Dunmore went away he states that
they were ordered home to put themselves
in readiness for a campain against
the western indians [inserted: the Cherokees] he states that he
reached home in September 1776 and
provided himself with shoes and clothing
and after a stay of not acceeding one
Page 9

week they then rendevouzed at New London
in Bedford County Virginia the same
company & field officers save that Genl
Nelson did not go & they were commanded
by Col Christie. from there they marched
to Long Island [inserted: on Holstein] Colo Morgan did not
[illegible] deal Christie with his regiment
untill they reached the long Island and
there Christie left orders that Col Morgan
should remain & build a fort He states that
he assisted in erecting the Long Island
fort until Col Christies return they were
then discharged verbally by Colo Christie &
Morgan's Regiment marched home in a
[illegible] he states that he got no written
discharge and after much toil & suffering
from cold and hunger he reached
home about the last of November 1776
this tour being of seven months his
ensign was named Thomas Threet
he then continued at home during the
winter of 1776 - 1777 and in the spring
of the last named year he again volutered 
in the State service and [inserted:] was employed to
assist in collecting military stores under the
direction & command of Quarter
Page 10

master of Commissary McGraw the store was
in Peytonsburgh [illegible] Pytsylvania [sic] via &
the stores were collected in the Counties of
Halifax & Pytsylvania [sic] in this service he spent
with his own Waggon and team which he furnished
four months & one half & was discharged
in writing by the said McCraw but
he has lost it by some casuality some years
ago he was discharged in the last of August
or first of Sept 1777 as well as he can recollect
the dates He states that he continued
at home until May of ____ year the
year of the great May frost. he them again
entered the United States services as a
volunteer in the Militia of Virginia
State Commanded by the same Captain
Rogers Lieut Irby ensign Wm Watkins they
joined the regiment at Salisbury North Carolina
his Majs name was Dunham his Colo Mason
Lieut Col. Loo Jones the regiment thus Constituted
& officered marched to Somer's plantation in
South Carolina & there joined the main
Army commanded by Genl Lincoln
his Brigadier he thinks was Davie but
of this he is not certain there they 
attacked a British fort on Stone or Storm [uncertain]
Page 11

6
River he thinks was in July he recollects
it was very hot the engagement lasted for
about 1 hour & 20 minutes his regiment with
other of the N C Militia & some regular
he thinks Commanded by Col. or Genl Davis
were drawn up in an old field when
about 300 Scotch Highlanders made a
sortie from a redouted and fired on
them & wounded his Lieut Irby who fell
in his arms his thigh was broken of which
wound he afterwards died he states he was
in the front of the left Column of infantry
who gave the pursuit & attacked the fort
they drove the Highlanders killing many
of them and reached the fort and he
had mounted the wall when order
for a retreat was given as he thinks by
Col. Williamson of South Carolina (who
was afterwards dismissed the service) he
then jumped down & made good his retreat
the Americans lost a good many troops in
the engagement there he remained with
his regiment until their term of three
months had expired & he was discharged
by Major Durham which discharge he
has since lost he means by three months
the time he actually remained in South
Page 12

7
Carolina with the main army but the
time spent in service between his departure
from home & his return was near 7 months
he left home about the 1st of May & got home in
November. Upon his return home he remaned
in Halifax & made many little tours in assisting
to collect stores, in Halifax & Pittsylvania and
in many little excursions & expeditions after
tories but having lost his discharge he cannot
speak with certainty of the length of time
he spent this summer he was however
generally employed this was in the sping &
summer of 1780 in the fall of that year Col
Boyd appointed him a sergeant and gave him
the command of 12 men and placed a magazine
of ammunition & stores & clothes &c at
Boyds ferry on Dan river [inserted: under his care]  Boyd was Col. 
Commandant of the County militia He states
that he took charge of it about the 1st
of November & guarded it there until
about the middle of February when
Cornwallis having driven & pursued Genl
Green across Dan River [crossed out: when] he took the
Stores out of the Magazine & placed them in
5 waggons and run them off to [crossed out, illegible] [inserted:] Halifax
Court house and [crossed out, illegible]
[crossed out, illegible] there had
Page 13

8
an interview with Genl Green who urged
him to run the stores out of danger he states
States that after some time he received orders from
Genl Green [inserted: by a messinger] to deliver the stores &c to some
receiving officer at Prince Edward Court
house which he accordingly did and
returned home and found that the British
had reached the ferry (on Dan River)
Kept by himself & [inserted:] his brothers & had destroyed
their farm burnt their fences destroyed their
Crop killed their stock and at that
point [inserted:] had turned back into North Carolina
[Erased/crossed out: When he got home]
He states that he made ready to join
Genl Green in the pursuit when the
quarter Master or Commissary McCraw
came and dispatched him to collect
waggons & and convey provisions to Greens
troops he employed 4 waggons & teams
& loaded them with meal and bacon
and overtook [inserted:] Genl Greens army at the
Reedy fork of Haw River [inserted: in N/C] they there
delivered their loading. they were
then dispatched back for more 
provisions & had collected part of their loading
when they received orders not to carry
it forward as the battle of Guilford had been
fought and the Virginia
Page 14

9
militia had been discharged here this
tour ended being about 4 months he
never recd a [inserted:] written discharge for this tour as
e was out at a distance from the army
and officers _ He states that during the
summer of 1781 he served a tour of three
months in the Virginia militia with his
waggon and team under the direction of
George Isbell who was wagon master they
[crossed out: handed] handed & collected provisions about
Prince Edward Court house and then
crossed James River & hauled from Goochland
& Albemarle Counties and delivered their
loading at Irvine Old Store below the
the mouth of Rockfish River on this tour
he served three months and was discharged
[crossed out: by] at Peytons bur by McCraw which is
likewise lost he states that about the 1st of
September in that year he volunteered and
joined the Virginia militia [inserted: the [illegible] troops were] under the
same Capt Rogers. John Brandon Lieut they marched
down the country and near Old James town
Via & joined Stephens Brigade of Virginia
Militia there Capt Rogers returned & Captain
Bates then took the command He states
Page 15

10
that before he left home he was appointed
Wagon Master by Colo Cole of Halifax
He states that the between James town and
Williamsburgh they had a skirmish with
the British and took from them the sheep
and cattle they had plundered and
their rear guard and pursued the
British down to York in Virginia they
were then attached to Genl Lawsons Brigade
Col. Richardson Commanded the regiment
& the Brigade in Lawsons absence. He states
that he had charge of [inserted: a brigade of] a bout 8 waggons as
Wagon Master and was constantly employed
hauling from James River to York River balls
bomb shells, plank &c for the purpose of
erecting & supplying the batteries, during the
seige, he was present when the British 
surrendered and with his waggons hauled
up 8 loads of the arms they grounded
on that. memorable occasion to the
quarter Master general at York. He
then as Wagon Master Voluntered and
assisted [inserted: with his brigade of Wagons] in Conveying the prisoners
having their baggage to Fredericksburgh Va
there they were divided and he with
Page 16

11
his brigade of Wagons accompanied the
Hessians & their guards to Nolands ferry in
the Potomac in the State of Maryland
there they delivered them to the Maryland
troops crossing them over the river being
the line between the states. Having performed
this service they marched homeward &
when they reached Leestown not [inserted: far from] Orange Court
house Major Wood Jones who commanded
the guards who delivered the Hessians to the
Maryland troops & who he had the 
command of his brigade of wagons there mounted
his horse & bade them all fare well
and this was all the discharge he got
he reached home about the fourth 
of December having served on this
tour as Wagon Master three months
closing his military career after a Service
of two years four months and one half
calculating only those tours in which he
served the length of three months and
making no estimate of numerous small tours
of from two days to one month scouting
after tories & indeed from the beginng of
service in the year 1776 until 1781
as stated he did little else than engage
Page 17

12
himself in the service of his country [crossed out, illegible]
had his form destroyed, and never drew
any thing or recd any compensation for
his services or the use of his wagon and team
He states that the several discharges mentioned
by him herein & the rect for the publick property
delivered at Prince Edward Court house
he had carefully preserved in an old pocket
book which he carried through the revolution
which he deposited in a chest but
upon making an examination about 5 years
ago he had the misfortune to find that the
book & papers had been wholly destroyed by
rats so that there remained not one that
could be read. & therefore has no documentary
evidence to prove his services nor
does he know of any living witness by
whom he can prove them owing to
the great age of himself and those with
whom he served they have withdrawn
from active life and if any be living by
whom he could make the proof he does
not know it or believe he could procure
it. He states that he resided
in Halifax County Virginia until
Page 18

13
about the year 1796 or 1797 when
he moved to Jessamine County Kentucky
where he resided two years he then
moved & settled on Russels Creek in
then Green now Adan County where
he has ever since resided
He states that in all the foregoing 
[illegible] he served as a volunteer on his
own account in the Virginia Militia
troops in the revolutionary army of
the United States that he never deserted
or left the service without being fully
discharged in writing or verbally and
he never was called on but he voluntarily
and cheerfully turned out at the call
of his Country
He hereby relinquishes every claim
whatever to a pension or annuity except
the present and declares that his name is
not on the pension roll of the agency of any
State
James Irvine
Sworn to and Subscribed
the day & year aforesaid
Page 19

14.
We Chasteen H Trahue a Clergyman residing
in the County of Adam and Nathan Gaither
residing in the Town of Columbia Adair
County hereby certify, that we are well
acquainted with James Irvine who
has subscribed and sworn to the to the
above declaration, that we believe
him to be 77 years of age, that he is
reputed and believed in the
neighborhood where he resides to
have been a soldier of the
revolution & we concur in
that opinion
Chasteen H. Trahue
Nathan Gaither
Sworn to & Subscribed
the day & year aforesaid

And the said Court do hereby declare their opinion
after the investigation of the matter and after putting the
interrogatories prescribed by the war department
that the above named applicant was a revolutionary
soldier and served as he states. And the Court
further certifies, that it appears to them that Chasteen
Trahue who has signed the preceeding certificate is a
Clergyman resident in the County of Adair and that
Doctor Nathan Gaither who has also signed the 
same is a resident in the Town of Columbia in Adair
County and is a credible person and that their
statement is entitled to credit
Page 20

I William Caldwell Clerk of the Adair Circuit
Court do hereby certify that the foregoing contains
the Original proceedings of the said Court in the
matter of the application of James Irvine for a
pension
In Testimony whereof I have hereunto
set my hand & seal of
Office this 4th day of September
1832 & 40th year of the 
Commonwealth of Ky.
Wm Caldwell C.C.A.C.
Page 21

James Irvine
14,250.
Declaration

V
Page 22

James Irvine
amd Declaration
for Pension

Filed June 3 1833 &
sworn to
Page 23

Personally appeared before me, the undersigned
a justice of the Peace in and for the County of
Adair James Irvine who being duly sworn
deposeth & saith, that by reason of old age
and the consequent loss of memory, he cannot
swear positively as to the precise length
of his service, but according to the best of
his recollection he served not less than
the periods mentioned below and in the
following grades: For two years and six
months as a private in the malitia service
and for such service I claim a pension
Joseph A Morrison
J. PAC
Page 24

By way of amendment and to fulfil to requistion
of the war Department the declarant
States that he is known in his neighbourhood
to Chasteen H. Trabue and Nathan Gaither who
have subscribed and sworn [inserted: the certificate attached] to the original
declaration and to a great many others that
would give their certificates and testify their
belief of his service as a soldier of the
Revolution as Trabue & Gaither have done
if it were necessary or required by
the department
James
Irvine

Kentucky
AdairCounty Set ⎬
I William Caldwell Clerk of the Adair Circuit Court
do hereby certify that the foregoing amendment was filed and
Sworn to in the Adair Circuit Court at their June term 1833 and
that it was ordered to be certified by said Court that it was their
opinion after the investigation of the matter that the statements made
therein are true. And I do further certify that it appears to
me that the declarant has made affidavit which is hereto
attached before Joseph A Morrison a Justice of the Peace
in and for the afsd County and that sd Morrison was at the
time of signing sd affidavit and is yet an acting Justice
of the peace in & for sd County and that [crossed out: the] faith and credit
should be given to all his official acts and
Page 25

that the signature to sd affidavit is his genuine signature
In Testimony whereof I have
set my hand & affixed my Seal
of office this 17 day of June
1833-
Wm Caldwell
Clerk of the Adair Circuit
Court

James Irvine
amd Declaration
for pension
Filed June 3_ 1833
Sworn to
Page 26

14.250
James Irvine
Kentucky

(e)
[illegible] private
14 months
$46.66/100

can only allow above.

Upton Miller
Columbia
Ken
Page 27

WAR DEPARTMENT.
Pension Office,

Sir:
The evidence in support of your claim, under the act of June 7, 1832, has
been examined, and the papers are herewith returned.
The following is a statement of
your case in a tabular form. On comparing these papers with the following rules, and
the subjoined notes, you will readily perceive that objections exist, which must be removed,
before a pension can be allowed. the notes and the regulations will shew what is
necessary to be done. These points to which your attention is more particularly directed,
you will find marked in the margin with a brace, (thus: }). You will, when
you return your papers to this Department, send this printed letter with them; and
you will, by compling with this request, greatly facilitate the investigation of your
claim.

A Statement, showing the service of James Irvine

Period when service was rendered.
1777

Duration of the claimant's service.
Years. ____
Months. 7, [crossed out: 4] not allowed wagon & team., 3, 0,  4, [crossed out: 3] wagon & team not allowed 
Days.

Rank of the claimant. Pr

Names and rank of the Field officers under whom he served.
Capn Kogers
Col Morgan

I am, respectfully,
Your obedient servant,
J. L. EDWARDS,
Commissioner of Pensions

7
3
4
Page 28

[See original printed document.  Doc 28]
Page 29

[See original printed document.  Doc. 29]
Page 30

Rev. and 1812
Wars Section.

February 23, 1924.

Fay Oliver,
320 Lafayette St.,
Jefferson City, Mo.

Madam;
February 23, 1924.
I have to advise you that from the papers in the
Revolutionary War pension claim, S. 4422, it appears
that James Irvine was born September 4, 1755 in 
Halifax County, Virginia, and was residing there when he
enlisted in the War of the Revolution.
He was allowed pension, for one year and two months
service as a private in the Virginia Troops, on his application
executed September 4, 1832, at which time he was a
resident of Adair County, Kentucky.
It is not stated whether soldier was married.

Respectfully,

Commissioner.
Page 31

Jan. 20, 1924.

Commissioner of Pensions
Washington D.C.

Dear Sir -
On Apr 30, 1923. I wrote you
asking for record on any family data
of the enclosed list, and up to this date
I have had no reply -
I inquired of these revolutionary
soldiers of Virginia:
James Irvine, (Irwin Ervin ) Halifax Co
Jacob Faulkner ..
____ Jennings ..
(I do not know this Jennings first name -but if you could
tell from the records which Jennings was from
Halifax - I be grateful)
Jacob Pugh Hampshire Co
Jonathan .. ..
Daniel Easley Halifax Co
Benjamin ..  ..

U. S. PENSION OFFICE
E
JAN 28 1924
Page 32

I shall be glad of any information
and any charge that may be
attached thereto - kindly advise
Others here who inquired of
several names at the same time -
have had their information months
go. Will you do me the favor &
courtesy to reply? Thanking you
I am
Very truly
Fay Oliver
320 Lafayette St.
Jefferson City - Mo -

U. S. PENSION OFFICE
E
JAN 23 1924
Page 33

4422

3 -- 068.
Old No. 3 - 649.
6 -- 20
Bureau of Pensions

James Irvine

So priv 1832
Adair Co. Ky - 76

Born Sept 4 1755 Halifax Co Va

76 Halifax Co Va

Capr Rogers
Col [Illegible] Morgan

[Illegible] - 7 m

[Crossed out: spg ILLEGIBLE Cap McCraw]
- Capt D
Col [Illegible]
Pvt 7 m

[Illegible] Stone
Page 34


Rev War

4422
INVALID.

File No. 4422
James Irvine
Pri. - Line

Act: June 7, 1832
Index: -- Vol. A, Page 188

[Arrangement of 1870.]

Va. Line, Apr. 29 1904.
Records corrected.
Page 35

Mch, 2-1903 Hist to
Florence M. Espy
Ft. Madison Ia

1924-Feb. 23. Hist to Fay Oliver
Page 36

BRIEF objections to the admission of Pension Claims, of which those
answered in the negative, in red ink, will apply to the claim of
[Crossed out: Robert Mason] James Irvine which require
further proof or explanation.

I. Does the declaration show where the applicant resides? yes

II. Did the declarant make the declaration in the county where he resides? yes

III. If the applicant did not make the declaration in the county where he resides, is there any reason assigned for his not doing so?

IV. Has the declarant mentioned the period or periods of the war when he served? yes

V. *Has he mentioned with precision the length of his service, and the different grades in which he served, in language so definite as to enable the department to determine to what amout of pension he is entitled? No [Crossed out: yes]

VI. Has he given the names of the officers under whom he served, in conformity with the regulations? [Crossed out: No] yes

VIII. Has the Court given their opinion? yes

IX. Has the Clerk given his certificate? yes

VII. Has he made a relinquishment of every claim to any other pension than the one under the Act of June 7, 1832? yes

X. Is the Clerk's seal affixed? And if so, has it a device or inscription by which it can be distinguished
from any other seal? [Crossed out: No] yes
Page 37

2
XI. Has the applicant obtained the evidence of a clergyman and another respectable citizen as to
their belief respecting his age and the general belief in his neighborhood relative to his revolutionary
service? [crossed out: 2 citizens] yes

XII. If the clergyman's affidavit has not been produced, is there any reason assigned for not obtain
ing it? [crossed out: No]

XIII. If the applicant has no documentary evidence, and has not obtained the testimony of at least one
living witness, has he stated in his declaration that such proof cannot be had? [crossed out: a witness] yes

XIV. If the applicant has produced a witness or witnesses as to his service, has the magistrate who
administered the oath certified that he, she, or they are persons of credibility? [crossed out: yes]
Has the official character and signature of the magistrate been certified by the proper officer under
his seal of office? [crossed out: No]

XV. Does it appear from any of the papers that the witness was in such a situation, or of such an age,
as to have a personal knowledge of the applicant's service? [crossed out: yes]

XVI. Are the papers authenticated as the regulations direct? No

XVII. Are the seven interrogatories prescribed by the War Department answered satisfactorily? And,
if not, which of them is not so answered? to D. [crossed out: 5.] 7.

EXPLANATORY NOTES.
QUERE V. In a case where the applicant cannot, by reason of the loss of memory, state precisely how
long he served, he should amend his declaration by making an affidavit in the following words:
"Personally appeared before me, the undersigned, a Justice of the Peace, &c. A. B. who, being
duly sworn, deposeth and saith, that, by reason of old age, and the consequent loss of memory, he
cannot swear positively as to the precise length of his service, but according to the best of his recollection
he served not less than the periods mentioned below, and in the following grades: For ____
year ____months and ____ days, I served as a ____. For ____months.
and ____days, I served as a____; and for such service I claim a pension."
Page 38

[See original document, Doc 38]