The Rhode-Island Republican. [volume] (Newport, R.I.) 1809-1841, 1828-08-21

Form Of a Declaration 10 be made By The
ONcefS.

lAJ
Form Of a Declaration 10 be made by The
0GcsfS.
For the purpose Of obtaining the bcne-
fits of an act, entitled "An act for the re-
lief of certain surviving officers and SOL
diers OF The Army of the Revolution" ap.
proved on the 18th of May, 1928, I,-of
-, in the county Of, Ia the State of
-, do hereby declare that was all Off
Ger IN the Continental Line OF the Army
of the. Revolution, and served As euch,
there insert, to The end Of the war, OF (as
the csee may be- to the time wien The ar
rangenent of the Army provided by the
resolves Of Congress of the 3D. and 2lst 9f
| October, 1890, was carried INTO effect, and
was reduced under that arrangement at
which period was ---- IN the ---- reg
! iment of the ---- line.
! And also declare, that afterwards re.
celved "a Certificate fconnnunly called a
communication cerlifcate) for sum equal
to the amount Of five years full pay; which
sum was offered by the resolve of Con.
gress, Of the 22d Of March, 1888, instead
Of the half pay for life, to which | was. en-
titled under the resolve OF tho 2lst OF Oc-
tuber, 1850.
ana 90 TURNER GecltTe, lhSt nave re-
ceived Of the United States. as pension
or, since the Sd lR' Of March, 1896, Here
insert, No .p''ruey, or, (as the case may be-
that .aye received, as pcnsioner of the
;. Tinted States, since the Sd day OF March
1928, the sum of - dollars, paid 10 me
by the agent for paying pensions in the
State of -.
Signed ,.r
Before me, -, here insert, Justice OF
the Peace, or other magistrate, duly EN-.
powered to administer oaths,] In the coun'
ty of -, in the State of ----, personally
appeared, this day, - and ----, OF the
said county, who di1, severslly make oath,
that ----,by whom the foregoing deelara.
ton was subscribed, is generally roputed
|: and believed TO have been an officer in the
Army Of the Revolution, IN manner as
therein stated
Witness my hand, thi; ---- day Of
in the year -
l., Clerk Of the Court of the County
| Of, in the State of -, do hereby Ger
tify, that -, before whom the foregoing
{ afiidaVits were sworn, was, al the time, .
- there insert, Justice of the Peace, OF
! other magistrate, duly empowered to ad'
! minister oalhs,l and duly empowered &c
administer oaths. L... .-..
In testimony whereof have hereuntC
? set my hand, and affixed the seol o
! LIS the said Court this cay oi
in the year
J. Form Of Declaration 10 be made by tn
non commissioned Officers, Musicians
and Privntes.
For the purpose Of obtaining the beneh
of.An ac, ,or the relief ofceriain surviving
officers and soldiers Of the Army ot th'
Revolution" approved on the 18TH Of May
Is2s. of in the County Of,
IN the State of do hereby declare the
2 I enlisted in the Continental Line OF th
} Army Of the Revolution, for and curing w
Y. war. and continued in its service until II
> terniizatlon; at which period was q User
J. geant. Corporal, musicisn. or private a
I. nsrv IN the regiment ofihe line
4. And | also declare that ] Afterwards rec
m a certificate for the reward oi eighty doIIi
h To which was entitled. under resolve
I'd Congress, passed the 18th OF May, i|'o.
B, And further declare that vas not o
a. The fifteenth DAY of March, 1879, On tn
y Pension List ofthe United States
ie [Sgnedl
= Rsfore me. there insert either Jui
or ticc ofthe Peace or other magistrate, do
n. enpowered to administer oalhs,J III III
he County Of IN the State VI pc
n. .opalIy appeared, ths day and
Of the said County, who did seveTally mai
n lo,,h that by whom the fore gong a.
NJ s',ra,ion vas subscribe, is generally
- nn,ed and believed To have been az enc
-. in the Army Of the Revolution 10 ms1o'
%. ,as therein stated.
pc Witness my hand, this e'y0i >
IS theyeay =.