Revolutionary War Pension and Bounty Land Warrant Application File R. 3400, John Wentworth, Mass.

SERVICE
NUMBER
Mass
Wentworth, John Eveleth, Sarah or Everith
R. 3400
CONTENTS
Former widow

We Aaron Eveleth and Mary Eveleth of New Gloucester in the County of Cum- berland and State of Maine On Oath depose and say that Sarah Eveleth our Step Mother Died September 12th 1837 and in her 97 year of her age I further Depose and say that I had her Death Recorded on the Town Book of New Gloucester and that the Records are correct
Witness John Mower
Aaron Eveleth Mary Eveleth
Cumberland J s Jan 23 rd 1853 The above named Aaron Eveleth and Mary Eveleth and made Oath to the truth of the above affidavit by them signed
Before me
William Bradbury Just Peace

State of Maine Cumberland ss
Cape Elizabeth March 9 th 1853
The following is an extract from the records of Marriages as returned and recorded in the Town Books of Cape Elizabeth
 " Clement Jordan Esqr & Sarah Wentworth of Cape Elizabeth Married April 11 th 1782  " Attest Ephraim Clark Pastor of a Church  " Recorded for David Steel Town Clerk 
Thomas Hannaford Town Clerk
I Thomas Hannaford on oath depose and say that I am Town Clerk of Cape Elizabeth aforesaid duly chosen and sworn that the records of said Town are in my custody and that the above extract was taken from said Records and is a true copy of the same
Thomas Hannaford
Cumberland ss March 14, 1853 Personally appeared Thomas Hannaford and acknowledged the above to be a true copy of the records
Before me W m C Mitchell Just of the Peace

A. H. Markland

Commonwealth of Massachusetts.
Secretary's Office, Boston :
June 20. 1853.
I hereby Certify, That, from an examination of the Books and Documents relating to Military Services in the War of the Revolution, which remain in this Department, it appears that The name of John Wentworth is borne on an abstract of travel of the Comp commanded by Capt John Wentworth, in Col. Aaron Willard's Regt. in July 1776. Miles 424. Discharged at Fort Edward. From Cape Elizabeth. Also on billeting roll Aug 20. 1776. Miles 140. from Cape Elizabeth. Also on return of Comp. "Commanded by Capt John Wentworth, in Col. Peter Noyes Regt. at Fort Hancock in Cape Elizabeth" May 20. 1777. Also Second year, 1777, Sept 10 th John Wentworth petitioned the Hon Council and the Hon. House of Representatives, for an increase of pay and rations. Also on abstract of the travel of Capt John Wentworth's Company, in Col. Aaron Willard's Regt. from the place of Abenethy Bennington Jan. 6. 1777. No of Miles 322. Also in Capt John Wentworth's Comp. Col. Gerish's Regt. of Guards stationed at Cambridge. from July to Dec. 22. 1778
See Mr. Brackett's Memo 32 Hyde Tilly Mem 1836

And I further Certify, That, before search made for evidence of said facts, the application hereto annexed was filed in this Office, in the form in which the same now appears; that the search was made by myself and my clerks alone; and that said application, and the certificate above set forth, contain all the facts and circumstances within my knowledge, pertaining to the case.
In Testimony Whereof, I have hereunto affixed the Seal of the Commonwealth, the date above written.
T. M. Wright Secretary of the Commonwealth.

To the Secretary of Massachusetts that I Foster Wentworth a soldier in the Army of the Revolutionary War" requests evidence of his Fathers services in the War aforesaid. This applicant believes that his Father went into the service from Cape Elisabeth in the County of Cumberland & State of Maine & he believes that his Father entered the service as Captain & served for several years, the exact time he is unable to State; that he has been informed & believes that the services were in part performed in Col Allen Willard & Col. Gerish's regiment of Artillery & under some other officers. He therefor requests the Secretary to examine the Rolls & the Revolutionary Documents in his office & grant a certificate of all the service of Capt John Wentworth of Cape Elisabeth
Foster
his X Wentworth mark.
State of Maine Lincoln ss June 24 1853, Signed before me
James Weymouth Just Peace

To be filed with the papers of Sarah Easton of Maine
Filed by A. N. Marshall Nov. 11. 1853.

I Timothy Jordan of Greene County of Pennebec and State of Maine aged 57 years on oath depose and say that I am a son of the late Abner Jordan and of the late Hannah Jordan Deceased formerly of Lisbon County of Lincoln and State of Maine my Mother was the Daughter of Captain John Wentworth and Sarah Evelett formerly of Cape Elizabeth County of Cumberland State of Maine I further depose and say that I Timothy Jordan and Nathaniel Jordan Wentworth B. Jordan John W. Jordan and Nathan B. Jordan are all the living children of the late Abner & Hannah Jordan abovenamed
Timothy Jordan
State of Maine Pennebec Jr. Dist. 12 th 1853 Personally appeared the above named Timothy Jordan and made oath to the above affidavit before me I further certify that the above affiant is a person of reput- -ability and veracity and that his statements are entitled to full credit - I further certify that I have no interest the case whatever
Arnold Wentworth Just. peace

I Sally Garcelon of Lewiston county of Lincoln and State of Maine Daughter of the late Benning Wentworth; on oath Depose and say that my Father Benning Wentworth Departed this life March 3 rd 1851 A son of Captain John Wentworth and of the late Sarah Eveleth formerly of Cape Elizabeth county of Cumberland and State of Maine; I further Depose and say that I Sally Garcelon of Lewiston county of Cum- -berland and State of Maine Do hereby certify that I am the only living child of the late Benning Wentworth ~
Sally Garcelon
State of Maine Lincoln ss. Sept. 12 th 1853 personally appeared the above named Sally Garcelon and made oath to the above affidavit by her signed to be true before me and that I not interested in the case. ~ Jesse Davis First Trial
I further certify that the above affiant is a person of responsibility and veracity and that her statements are entitled to full credit. ~
Jesse Davis

State of Maine Lincoln } ss county } I
Arnold Blaney Judge of the Court of Probate within & for said county the same being a court of record do hereby certify that satisfactory proof has been exhibited before me that Foster Wentworth of Webster in said county is the only surviving child of John Wentworth & Sarah Eveleth late of Cape Elizabeth in the County of Cumberland in the state of Maine. Anna Sally Garrison of Lewiston in said County of Lincoln - and Timothy Jordan, Nathaniel Jordan Wentworth B Jordan, John W Jordan & Nathan B Jordan of Green in the County of Kennebec state of Maine. grandchildren of the said John Wentworth & Sarah Eveleth are the only surviving heirs at law of the said John Wentworth & Sarah Eveleth -
In testimony whereof I have hereunto set my hand & affixed the seal of the Court of Probate the twenty first day of September 1853
Arnold Blaney Judge

State of Maine.
Lincoln County } ss. Office of the Court of Probate I, Erastus Foote & Register of Probate for said County hereby certify that Hon. Arnold Blaney whose name is signed to the foregoing certificate is Judge of Probate in and for said County and duly commissioned and qualified agreeably to the Constitution & Laws of said State, that the annexed signature purporting to be his is genuine & that full faith & credit are and ought to be given to his Official acts and attestations.
In testimony whereof I have hereunto af- fixed the Official Seal of said Court and Subscribed my name this twenty first day of September 1853. Erastus Foote Reg t of Probate

SUICIDE IN PORTLAND JAIL. —Arnold Wentworth, of Greene, who was arrested by the United States Marshal on Tuesday last, charged with committing frauds upon the Pension Department, was brought before John Rand, Esq., U. S. Commissioner, on Wednesday, and ordered to recognize for his appearance yesterday P. M. at three o'clock. Failing to find sureties, he was committed to jail.
Yesterday morning he sent the boy who attended him at the jail, with a note to his counsel in relation to giving bail; and a short time afterwards was found lying on the floor in his cell, with his head resting on the back of a chair which he had turned down for the purpose, and with his throat cut from ear to ear. The wound was such as to have occasioned death in a few moments, and he evidently did not move after the act was committed. The razor which he had obtained to shave himself with, and with which he inflicted the wound, was found near his hand, by his side.
Coroner Danielson was called in, and the jury rendered a verdict in accordance with the above facts.
The unfortunate man had shown no evidences of mental aberration, but had been, during his confinement, very calm and gentlemanly in his appearance, even in making his request for the razor. The examination of a physician of the coroner's jury, showed that one jugular vein was entirely severed, and the other partially so; also that the windpipe was very nearly severed. He had evidently bled very freely.
It is supposed that the discovery and exposure of a series of most improper and dishonest transactions impelled him to the desperate deed.
For the foregoing particulars of this sad affair, we are indebted to Mr. Baker, the jailor.
Not long after the above dreadful deed, we were in the jail, and saw the corpse of the poor self-murderer. It was that of a man evidently somewhere near the meridian of life, with a countenance indicative of intellectuality, and expressive of the repose succeeding "life's fitful fever." He had been a justice of the peace, was a man of property and standing to the day of his arrest, and leaves a family to mourn his untimely end.
Since the foregoing was written, we have learned, through the politeness of Mr. Shepley, District Attorney, the circumstances which led to the arrest of Wentworth.
The forgeries, of which he was accused, were committed in papers made out to sustain the application of one Foster Wentworth (father of deceased) for a pension, as heir at law of Sarah Eveleth, mother of said Foster Wentworth. In order to entitle the applicant to the pension, it was necessary that the said Sarah should have been alive March 4, 1831, and the declaration, subscribed and sworn to by Foster Wentworth, alleged that fact. The certificate of her death, by the Town Clerk of New Gloucester, originally certified that she appeared, by the town records, to have died on the twelfth day of September, eighteen hundred and twenty-seven. This certificate was altered, in two places, so as to make the time of her death in thirty-seven instead of twenty-seven . One alteration was that of the word "twenty" to "thirty," by changing the w into an h . The remainder of the word was left untouched; the n remaining very plain and distinct where there should have been an r to have made it read "thirty." The difference of ink is also very perceptible—that in which the alteration was made being very much darker than that of the original certificate. The other alteration was made in the figures "1827," the 2 being changed to a 3. The difference in the ink in this alteration is also very perceptible. In fact, these alterations were made in a manner so bungling, that a casual observer could hardly fail to notice and detect them at the first glance. Then followed what purported to be the affidavit of Aaron Eveleth and Mary Eveleth to the fact of the death in "1837," certified to by William Bradbury, Justice of the Peace. It became evident, upon examination and inquiry, that the signatures to this affidavit, and what purported to be the magistrate's certificate of oath, were forged, and were in fact all in the handwriting of one individual, and that individual Arnold Wentworth, under whose direction the application and papers had been made

The remainder of the word was left untouched; the n remaining very plain and distinct where there should have been an r to have made it read thirty." The difference of ink is also very perceptible—that in which the alteration was made being very much darker than that of the original certificate. The other alteration was made in the figures "1827," the 2 being changed to a 3. The difference in the ink in this alteration is also very perceptible. In fact, these alterations were made in a manner so bungling, that a casual observer could hardly fail to notice and detect them at the first glance. Then followed what purported to be the affidavit of Aaron Eveleth and Mary Eveleth to the fact of the death in "1837," certified to by William Bradbury, Justice of the Peace. It became evident, upon examination and inquiry, that the signatures to this affidavit, and what purported to be the magistrate's certificate of oath, were forged, and were in fact all in the handwriting of one individual, and that individual Arnold Wentworth, under whose direction the application and papers had been made out and forwarded.
When brought before Commissioner Rand on the first complaint, he waived an examination. A second complaint was then filed, and he was ordered to recognize with sureties for his further appearance yesterday afternoon, in the sum of $5,000. There was then some negotiation between his counsel (Gen. Fessenden) and the District Attorney, as to the amount of bail which would be finally insisted on for his appearance at Court; the District Attorney expressing a willingness to accept of bail in such an amount as he supposed would be in his power to procure, but which would at the same time be a secure his appearance for trial. It was understood that he had property to the amount of some $2500 or $3000, and the attorney signified his willingness to accept bail in that amount. Thus the case stood when he effected his own discharge from all human courts, trials and penalties, by depriving himself of life. What an enigma is the human character! In an evil hour, and tempted by an evil spirit, he conceived the idea of perpetrating this fraud. To his inexperienced mind, it seemed possible and even easy to do it without detection. He little knew how keen and sharp sighted men are made, when their position and duties make them comparatively familiar with such offences, and the manner in which they are usually committed! What agony he must have endured during the short time he was under arrest! And even in this, his last desperate act, he must have been moved by a strange mixture of conflicting feelings. He might have procured bail and escaped trial. But it would have taken his whole property, and his reputation and character were gone. Life had lost its charms for him. Perhaps he thought of his family and preferred that his property should go to them, rather than satisfy the demands of an outraged law! He could not endure the ills which pressed upon him, and so he fled to those he "knew not of"—a melancholy warning to all to beware of temptation!

State of Maine and County of York on the Book of Records I find the following ab- stract - Capt John Wentworth died June the ninth in the year of our Lord Seventeen hundred and eighty one
I certify that the above is a true copy of the Records of the Town Kittery with the exception of the date which is expressed on the Records in faint legible figures as follows June 9 th 1781
Benning Waley Town Clerk
I Benning Waley above named, depose and say that I hold the Office of Clerk in the Town County and State aforesaid, and that the above is a true extract from the records of said Town with the exceptions above named, as certified by me Benjamin Waley Town Clerk
Personally appeared the above named Benning Waley Esq and made oath that the above is true. Before me
M. T. Wentworth Justice of the Peace

State of Maine and County of York on the Book of Records I find the following abstract
Capt John Wentworth and Miss Sarah Bartlett both of Kittery Me was married September the seven- teenth in the year of our Lord Seventeen hundred and sixty two - Benning Halley Town Clerk
I certify that this is a true copy of the Records of the Town of Kittery with the exceptions of the date which is expressed on the Records in fair legible figures as follows September the 17 th 1762 Benning Halley Town Clerk
I Benning Halley above named depose and say that I hold the office of Town Clerk of the Town of Kittery in the county of York and State of Maine, and that the above is a true extract from the records of said Town with the exceptions above named as certified by me Benning Halley Town Clerk
Personally appeared the above named Benning Halley Esqr and made Oath that the above is true Before me M. P. Wentworth Justice of the Peace

In a book of Records of the Town of New Gloucester County of Cumberland & State of Maine kept for the purpose of recording Marriages I find the following extract viz "December the fourth eighteen hundred and six Capt. Nathaniel Ereleth with Mrs Sarah Arnold both of New Gloucester
By Elisha Moseley Minister of the Gospel
I certify that I am Town clerk of New Gloucester that the Records of said Town are in my custody that the above is a true copy of the record with the exception of the date which is in fair legible characters thus "Dec r 4 th 1806"
Elisha H Moseley Town Clerk Cumberland Jan. February 25 th 1853
Personally appeared the above named Elisha H Moseley and made Oath that the foregoing Certificate is true
Before me
Samuel Foxcroft Just Peace

18 We the undersigned Jonathan Haskell and Deborah Haskell daughter of the late Capt Beldad Arnold of New Gloucester in the county of Cumberland & State of Maine depose & say that said Beldad Arnold died December 1 st AD 1805 at said New Gloucester as we have his death recorded in our family Bible and the record of his death was made at the time of his death His Funeral & Burial was on Thanks giving day of that year Jonathan Haskell Deborah Haskell
Cumberland ss May 6, 1853 Then the above named Jonathan Haskell & Deborah Has- kell made Oath to the truth of the above affidavit by them signed
Before me
William Bradbury Justice of the Peace

We the undersigned Charles Perle and Mahitath Perle of Cape Elizabeth County of Cumberland and State of Maine on oath depose and say that the said Clem- ent Jordan Esqr Died February 19 th 1793 at Cape Elizabeth as we have his death recorded in our family Bible and said record of his death was made at the time of his death
Attest
Andrew Perle
Charles his Perle mark
Mahitath Perle
State of Maine
Cumberland ss May 16 th 1853
Personally appeared the above named Charles Perle and Mahitath Perle and made oath to the truth of the above affida- -vit by them signed. Before me
W m Mitchell Jus of the Peace

State of Maine Cumberland Is
Cape Elizabeth March 9 th 1853
The following is an extract from the record of Marriages as returned and recorded on the Town Books of Cape Elizabeth
Capt Bildad Arnold of New Gloucester and Miss Sarah Jordan of Cape Elizabeth were married March 12 th 1795
Attest Ephraim Clark Pastor of a Church
Recorded per Eben Sawyer Town Clerk
Thomas Hannaford Town Clerk
I Thomas Hannaford on oath depose and say that I am Town Clerk of Cape Elizabeth aforesaid duly chosen and sworn, that the Records of said town are in my custody and that the above extract was taken from said Records and is a true copy of the same Thomas Hannaford
Cumberland Is. March 14. 1853 Personally appeared Thomas Hannaford and acknow- ledged the above to be a true copy from the records
Before me W m C Mitchell Just of the Peace

The original paper sent to the U.S. District Attorney for the State of Maine.
— Oct. 17. 1853. —
B. B. 125.34

New Gloucester Sept 30. 1853
In a Book of records of the town of New Gloucester County of Cumberland and State of Maine kept for the purpose of recording births and deaths I find the following extract, viz Sarah Eveleth widow of Capt Nathaniel Eveleth died September the twelfth, eighteen hundred and twenty seven.
I certify that I am Town clerk of New Gloucester, that the records of said town are in my custody, that the above is a true copy of the record with the exception of the date which is in fair legible characters, thurs September 12 th 1827.
Elisha H Hovey Town Clerk
Cumberland ss Sept 30 th 1853
Then personally appeared the above named Elisha H Hovey the town clerk of New Gloucester and made oath to the truth of the foregoing certificate by him signed
Before me
Samuel Dorrance Just. Peace

9 In a Book of Records of the Town of New Gloucester County of Cumberland & State Maine Kept for the purpose of recording births and Deaths I find the following extract viz Capt Nathaniel Eveseth died November the twentythird eighteen hundred and twenty four I certify that I am Town Clerk of New Gloucester that the records of said Town are in my custody that the above is a true copy of the record with the exception of the date which is in fair legible characters thus "Nov 23 d 1824" E. M. Moseley Town Clerk
Cumberland ss February 25 th 1853 Personally appeared the above named Elisha M. Moseley and made Oath that the foregoing Certificate is true Before me Samuel Foxcraft Just Peace

11 In a book of records of the Town of New Gloucester County of Cumberland & State of Maine kept for the purpose of recording Births and Deaths I find the following extract, viz Sarah Erelith widow of Capt Nathaniel Erelith died September the twelfth eighteen hundred and thirtyseven I certify that I am Town Clerk of New Gloucester that the records of said Town are in my custody that the above is a true copy of the record with the exception of the date which is in fair legible characters "thus" September 12th 1837 E. H. Moseley Town Clerk
(Cumberland ss February 23 rd 1853 Personally appeared the above named Elisha H. Moseley and made oath that the above certificate is true Before me Samuel Davenport Just Peace

State of Maine County of Kennebec S.
In this 23 day of June in the year of Our Lord One thousand eight hundred and fifty three before the District Judge of the Court of the United States for the District of Maine personally appeared John Wentworth who is known to said Court as a resident of said county aged years, and who being first duly sworn according to Law doth on his oath make the following declaration in order to obtain the benefit of the provisions made by the act of Congress passed the 14th of July 1836 viz that he is the only child and heir at law of Sarah Estlin deceased, who was the widow of John Wentworth deceased who was a Captain in the service of the United States in Command during the War of the revolution that his said father John Wentworth was born in Rutland, and from thence removed to Cape Elizabeth in the County of Cumberland & State of Maine and resided there at the commencement of the War, and continued to reside there until his death that he entered the service as a Cap- tain and served for several years, the exact time he is unable to state that he has been informed, and believes that the services were in part rendered in Col. Allen's Battery,

and Col Genesee's regiment of Artillery that his father the said John Wentworth and the said Sarah Ennett then Sarah Bartlett, were married at Kittery in said State on the (17 th ) seventeenth day of September in the year 1762 seventeen hundred and sixty two that his father the said John Wentworth died at Cape Elizabeth in said State on the ninth (9 th ) day of June in the year seventeen hundred and eighty One that his widow said Sarah Wentworth (late Sarah Bartlett) was married one Clement Jordan on the eleventh day of April in the year seventeen hundred and eighty two, that the said Clement Jordan also died on the 19 th day of February in the year seventeen hundred and ninety three That after the death of the said Clement Jordan in said State on the twelfth day of March in the year One thousand seven hundred and ninety five, the said Sarah widow of the said Clement Jordan formerly widow of John Wentworth married one Beldad Arnold of New Gloucester Maine and that her then husband, the said Beldad Arnold also died on the first day of December in the year eighteen hundred and five
That after the death of the said Beldad Arnold as is above mentioned the said Sarah widow of said said on the fourth day of December in the year One thousand eight hundred and six married Nath- aniel Ennett and that her husband the said Nathaniel Ennett died on the 23 rd day of November One thousand eight hundred and twenty four having the said Sarah his widow

That the said Sarah the widow of Nathaniel Estlin (and who had formerly been the widow of Bildad Arnold and of Clement Jordan, and of John Wentworth the father of this deponent) died on the twelfth day of September in the year One thousand eight hundred and thirty seven (1837).
Witness
(signed)
Adam Wren
Porter his X Wentworth mark
Subscribed and sworn to before me the day and year first above mentioned and I certify that I have no interest in the application as attorney agent or otherwise
Adam Wren
District Judge of the United States for the District of Maine
I do hereby constitute and appoint Samuel M Knight of Washington D.C. my true and lawful Attorney for the purpose of prosecuting the my application for a pension, to attend to the same while pending and to receive the certificate when issued, and to do all things necessary & proper, as fully as I could do when I personally pre- sent. dated this                      day of
Witness
Adam Wren
Porter his X Wentworth mark

A D 1853
Foster his Wentworth mark
Corn Evelith Mary Evelith
State of Maine County of Kennebec
It is hereby certified that satisfactory evidence has been exhibited before me the undersigned Judge of the court of a court of record held in and for the said County that Sarah Evelith formerly widow of Nathaniel Evelith and who was formerly the widow of John Wentworth a reputed Revolutionary Officer died on the 13th day of September Eighteen hundred and thirty seven, and that he left surviving him the following named widow and children viz Benning Wentworth Foster Wentworth and Hannah Jordan
Witness my hand this 23 day of June A D 1853
Asahel Warr
District Judge of the United States for the District of Maine

No 7983 Sarah Loveth. Maine.
Let. A. H. Markham,
Spt. 21 / 53
Let. G. T. Shepley N. J. D. Marks,
Oct. 17 / 53 Noy 12 1853 July 4, 1853

Commonwealth of Massachusetts.
Secretary's Office, Boston;
Sept 13 1853.
Sir:
I hereby certify that the certificate of services granted on application of Foster Wentworth (No. 5.324) for the Revolutionary services of his father were all of them performed by Captain John Wentworth and not by a soldier of that name In witness whereof I hereunto affix my name and seal of office this thirteenth day of September One thousand Eight hundred & fifty three
E. M. Wright Secretary of the Commonwealth

Lovely Alameda
Good News

Office of A. T. Almon Portland Maine
Nov. 12. 1853
Sir
I have the honor to acknowledge the receipt of yours of the 10 th instant. The information desired I presume you have ere this received in my letter of the 10 th instant - I said, that in the hurry of professional engagements I omitted to acknowledge, at the time, the receipt of yours of the 17 th ult, although I was under the impression that I had done so. I enclose an extract from a newspaper containing some particulars of the melancholy termination of the case. On the inside of this sheet will be found a copy of the only paper left by Wentworth which may possibly lead you to think it advisable to have the papers scrutinized in the cases referred to.
I have the honor to be
Most Resp t Your Obed t Serv t
G. S. Shepley
Hon S. P. Waldo Coun t of Prescot -

✓ Thomas Elyot Nov 28 et
✓ None Elyot 38 19
✓ 1676 Summary Elyot Nov 26 et
✓ Mary Elyot Nov 28 19
✓ Richard Elyot Nov 28 et

Copy of paper left by Wentworth
"Osyp Kronick owes on William Hunt case 25 dollars; and between 200 & 300 dollars John Freye case (Baudoin), and 200 or 300 on Capt Harden case (Brunswick) and he has got the widow Anu certificate I know not how much for, one half is mine, and he will get the Nathan Kearn's case (Prague) one quarter is mine, and one dollar on Joseph Morill case and some others that I cannot remember"
Col. Koyet Mar 28 AD Short split ad on them. Jordan Farm Mar 30 AD For Roder Mar 28 AD Clon Mery Mar 28 AD Hogan Salcam Mar 28 AD Bulle Mayard Mar 28 AD Bazg. Elyah us. Combs Mar 28 AD Mrs. Turner Mar 28 AD

Open
3400 P. O. Sarah O'Leith
Service: _____
REJECTED
Enlisted: _____, 18
Discharged: _____, 18
Application filed: _____, 18
Alleges: _____
Re-enlisted: _____
Attorney: _____
P. O. _____
_____ Recognized. _____ Contract.
_____ Cert. of Dis. Searched for _____, 18