Daily evening star. [volume] (Washington [D.C.]) 1852-1854, 1853-07-25

instructions for the information of claimants and
others.
Respectfully, your obedent servant,
J. NJ. BRODHEAD,
Comptroller.
To ALBERT G. ALLEN, Esq,
Navy Agent, Washington, d. c.
FORM FOR A PERSON CLAIMING AS PETTY
OFFICER, SEAMAN, ORDINARY SEAMAN,
OR BOY. WHO is NOT IN THE NAVAL SER
VICE, BUT WH0ePRODUCES A CERTIFI-
CATE OF DISCHARGE.
], do solcmnly swear that
] am the identical who served
by that name as a on board the United
States ship :. in the Pacific. Oh the
coast of California and Mexico, from to
lS and who is named in the GER
tificate of discharge dated ,lS signed
by which is herewith presented and
surrendered. | also sOlennly that l am
now years OF age and a native of
land that before my service in
the vessel above named, | performed my duty on
boardthe Having been trans
ferred from the rendezvous, where
enlisted on or about the day of
,ls !, into the grade of /,
and by the name of
(To be signed by claimant)
Sworn to and subscribed before me, tins
day of "A. ID. Is And | here by
certify that the abovenamed deponent appears to be
about the age stated by him. that he is about
feet inches in height; of
complexion, hair and eyes,
Cro be signed by authenticating officer.)
Form of Receipt Of Claimant.
Received this davo
IL of Navy Agent at Washing
ton, ID. c., the sum of dollars. and
cents, in full for services rendered by me OH board the
United States ship III the Pacific, on
the coast OF Mexico aud California, in the year
for which services extra paw is
granted by the act of Congress entitled 50 An act
making appropriations for the naval service for the
year ending June 30, lS5 -
In Ip nd i'm htf,it, TO bt rln
Form Of acknowledgment Of Receipt.
STATE OF
On this day of A. d. IS5 .
before me ,, in and for
the county and State aforesaid, personally appeared
who signed the foregoing
receipt IN duplicate, in my presence; and certify
| have served on board the U. s ship
III the Pacific, on the coast of Mexico and California
i'll the year
(To be signed by authcnticating otlicer.)
Form Of Certificate Of Identity by an Officer.
certify that the above receipt in duplicate was
signed III my presence by whose
person is well keown TO me- and the said
did aiy to the Iigindk thereof his discharge rs a
from the L. :. ship g, and
know him to be the Identical person named said
discharge.
II the ccrfifc of Commissioned or ,.nrrant
officer cannot be obtained. He claimant iH state
o1th gtring the rcdsos, and the affidavit of tTo Cqedi
bic and dsintcreted itneSes ,cR BE- required instead
as folious:
Form Of affidavit for tpo uitncsscs.
STATE OF
County of go
On this day of
lS5 before me.a IN and for the State
and county aforesaid, duly qualified TO administer
oatis, personally appeared residing
at and CmplOYpi as
and also residing at
and employed as who known
to me credible witnesses, residing and employed
| as stated, and who, being duly sworn, deposc and
say, that they reside and employed aforesaid
that they have personal knowledge of
who signed the foregoing receipts their presence
and that he Is the Identical who
served OH board the u. 5. ship as a
from to
and who Is named i'll The discharge dated ,
and signed by which lc affixed in
their presence to this original receipt that their
knowledge of him obtained there stcte fully hop
offGinedwhcther from serrins ruth him bodrdShip.
or otherwise. And they further deposc that they
have 10 interest III the claim of the said
for extra pay.
Sworn to and subscribed the day and year above
written. Before me
Cro be signed by the aulhenticaing officer)