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Status: Page Status Needs Review

Date Stamped
Mar 18 1880
Pension Office

WIDOW

CLAIM FOR PENSION

Ary Smith, Applicant
Widow of Jack Smith
C Co 100 Reg't
U.S.C. Troops Vols.

Filed by
W []
Dayton
Ohio

Also personally appeared Madison Nichols residing at
Xenia and Arthur Jackson
in Xenia Ohio, persons whom I certify to be
respectable and entitled to credit, and who, being by me duly sworn, say thay they were present and saw
Arly Smith, the claimant make her mark to the foregoing
declaration; that they have every reason to believe from the appearance of said claimant and their acquaintance with her that
she is the identical person she represents herself to be; and that they have no interest in the prosecution of this claim

Mat Nichols
Arthur Jackson
(Signature of Witnesses)

Sworn to and subscribed before me this 28 day of February A.D. 1880
and I hereby certify that the contents of the above declaration, &c., were fully made known and explained
to the applicant and witnesses before swearing, including the words ___
____erased; and the words__________________
______added; and that I have no interest, direct or indirect
in the prosecution of this claim.

[] Orr Clerk of Court
(Signature)
of Com Pleas Greene Co Ohio
(Official Character )

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