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Sworn to and subscribed before me, this
.day of.,
"I do solemnly swear (or affirm) that I was a Confederate soldier, sailor or servant of such Confederate soldier or sailor (as the case may be); that I was honorably discharged or parolled, or did not desert from the Confederate service (as the case may be);	that I reside in this	State;	that I	am Indigent and	infirm; that	I am not able to	earn a	support,
and have no relatives	able, whose duty It	Is to support	me; that I nor my wife do not	own property, real or personal, to
the value of $2,500.00;	that I nor my wife have not	conveyed any of my or	her property	to any one witli	a view	to drawing a pension, so help	me God.?
Sworn to and subscribed before me
(Signature of Pensioner) , thls?2v*n5/!day
AFFIDAVIT OF TWO WITNESSES.
We, the undersigned, verily believe the facts stated in the above application to be true and'the applicant to be the Identical pei-son named in the said application.	_
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Sworn to and subscribed before me, this
J/xuaCs..
(SlgnatureS?{^VH}iess) /
3 of Wityess)	'J? j""	- r-
OFFICE OFj CHANCERY CLERK AND COUNTY BOARD OF	...COUNTY
..........................................MISS................................/....&....^7-.........192./....
We, the undersigned members of the Board of Inquiry, hereby approve the foregoing application of
...........for pension because we know the applicant
.tobejndigenbf'and physically unable to earn a support by his own labor caused by wounds or injuries re-, ceived durlnfTfie CfvirWM,* SBd'tliafWe 1b^H4V?'ilie'ta5t8''BiaiBU?1i{*UlBrKDWff^ppticandn*^rr'(ni?r'and??tliii-
party should receive a pension.
Given under our hands and seals of office, this. JO............................
..day of ...................................................192../.
Chancery Clerk
(Seal)	O :1 ; *
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(Seal)	Clerk
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N. B.?If the Board approves this application, the Chancery Clerk will so certify, after recording the same in a book kept for that purpose, and forward all of the approved applications in a body (not one at a time) to the Auditor?s office by the first day of October.
No application forwarded after that time will be received.
Rejected ^applications should not be forwarded to this office.
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