Patrick Sullivan Civil War Pension File
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Transcript of Patrick Sullivan Civil War Pension File
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&.;•Tt«/
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ElMBURSEMEPIT
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A.CT OF JULY 14, 1862. . ;
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Declaration for the Increase of an Invalid Penfeionl
TAKE NOTICE. — If this declaration is executed before a. Justice of the Peace or a Notary Public, the certificate of tli«OLEKK OF THE COTJBT, is to the official character and genuineness of the signature of such officer must he attached.Xeglect to comply with this requirement will cause trouble and DELAY.
State of .t 00.
ON r..A. D. one thousand eight hundred and eighty
•=^L within and for the County and State
-- County nt..;.,-.-<S7
United States, enrol)«<1 at, thn
dollars per month, Certifleata "**
.years, a resident
.......State of
who, being duly sworn according to law, declares that he Is a pensioner of the
________ Pension Agency at the rate of J
, by reason of disability frrnn ^-(Here name the disability for which pension wwgranttd.)
Incurred in the(illUtary or S T
.service of the United States, while serving as a..(Here elate rank, company^cffld regiment, II iu Jhe wrmvj, ve»»e)
if in the Navy.) //t/
That he believes himself to be entitled to an Increase of pension on account ot-
. H ott account of increase in the disability for(Here state the reasons tor
^o -- -foryifmich' not pensioned, the location of (the wound or injury, the name of the disease* and tlxe time, placep
If on account of
Jfi"circuinstanc3' of its origin, and the names of ospitalswUere treated in the se u y stated he dates of treatmeni
should be Riven an nearly aa possible.)
Mint lie hereby fippoints, with ful l power of substitution and revocation
-fa., of „.
liis true and lawful attorney , to prosecute his claim.
His Post Office address is r c<~-^7-&£-<^? t-^?^^:>?&<s'
>*~
Two witnesses who <-an write sign here.l
—7^-
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Also personally appeared K .rr.rr.TrT l^,,...«...,/^.../.!?±X™-/ '.residing at .../.f..
and <rrT..4<fe<?. .^...'^^^...^.."..^..^ residing at
...persons whom I certify to he respectable and entitled to credit, and who
$2 J ~ J / /] J*/ *"*being by me duly sworn, say that they were present and saw \l.. .w-^^sdtf.-.fe^dk .j/d/.. ..fr^^fcfe^T! ..!4f7r?^Vr-
, , the claimant IJJJTI liirc HBHM (make his mark) to the foregoing
declaration ; that, they have every reason to believe from the appearance of said claimant and their acquaintance with him that
he is the identical person he represents himself to be; and that they have no interest in the prosecution of this claim.
[if AJflants sign by mark, two persons who can write si^n hero,] [Signature of Amanis.J
Sworn to and subscribed before me this ±£ day of . ..... ... r T /f '* '. A. D. :
and I hereby certify that the contents of the above declaration, (fee., were fully made known and explained to the
applicant and witnesses before swearing, including the words.... ..,„
i— i . erased and the words
rr....added ; and I have no interest, direct or indirect, in the
prosecution of this claim.
[L. S.]
I, :.^.... , Clerk of the Q#unty Court in and for aforesaid County
and State, do certify that , Esq., who has signed his name to the
foregoing declaration and affidavit was at the time of so doing..... in and
for said Co'unty and State, duly commissioned and sworn; that all his official acts are entitled to full faith and credit, and
chat Ms signature thereunto is genuine.
Witness my hand and seal of office, this-. day of , 188 .
[L. S.] Clerk of the...
NOTE.—This should be sworn to before a CLERK OF COURT, NOTARY PUBLIC, or JUSTICE OF THE PEACE.If before a JUSTIpE or NOTARY, then CLERK OF COUNTY COURT must add his certificate of character bereon, andnot on a separate slip ol paper.
RH
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O
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Acts of July 14,1862, and March 3,1873.
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Disability,
County,.-.(6840—50 M )
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__
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On this .... _ S £ * G .. „ .day of
late of Co.—^SL —of the // Regiment of-
for an Invalid Pension.
STATE — "1A " f
County ofA. D. one thousand eight hundred and sixty-.. «^n^^^L_.?!?i -l personally appeaSmf'before me, Clerk of the
being a Court of Record within and for the County and State aforesaid, and by
law duly authorized to administe^ oaths for general purposes, and having custody of the^ official seal of said Court,
' y e a r s , a resident o f
County of -<3rr?^OAfe^=fe? in the State of
who, being duly sworn according to law, declares that he is
who enlisted in the service of the United States at '*3Lfa-_ <^JsS^t/is±£>_ .on
day o f _ . _._gp?^^<^u«-4*/ 186/ , as a x.'^jfJC.^fM:-'. '.'_-' in the Company commanded by
.^^k^S^.'^.Aife^^^ , kiiownj^Company^^/jL^—^in Jhe._^,_^^^^rI \s /ft / £~ '
Roffimcu't of,(JyW../Sxi4xfc^A-. . . _ . , . , „ , , , . , . - -_ , _ / s^-Cr*es^-*-~*~<'
-*-- volunteers, in the war for the suppression of the Rebellion in
certain States of the Union , and far the maintenance of the Federal Government, and was honorably discharged on the
. . . . &2/j3. ........... day of ________ V: •^^^^^^^^^ - ..... in the year 186^ , as appears on the Muster Roll of said Company,
and also on the Surgeon's certificate of disability, 'which is filed in the Pension Bureau at Washington, and is to be deemed
and treated as part hereof, and that ho.was discharged at ______ *>£3><z~- - - , S*£~. S?>r±s±?9- ..... _^_?7?L^v ____ ...... ________ by reason of
' That while in the,
said service, and in the line of his duty, he received the following wounds or disability, to-wit: OnAthe
day of , -O-I^L __ . . , A. D. ** '&*-*isjk.<StTTt<*it - <2^x*jrrs-v^
j t ~ / " A— r ,/~ ' / /J?f^-^^ t7
^^y-
*3&lJi&UjL^-^^-&tts&J&^^ &CsXtS>~M^e^. --£?^L<f>~*^*(^
I A t , •If i in ' ,t.^jAFf±~!?^--<»b?Cl<4<3^1sZto^r&
, - - . - , -t^r^\~£<_^>iA*4*~£is/ j(.s£L^Gr?~*t~^ • *Vf- ,^f4H<* — ?— t f -Y^vsociX /1 — Xfer^zx l *^a«v £i~~f*+J I A — Vi<£- /This applicant'stsEennMhisT^stlJffice iaofdress is ^£§^^£^7 ^ __UountyofXT" f ^^ A^zJ^S i// ^State of _______ O?TM<- o ^^ -t T. _______ ; and this applicant solemnly, swears that he has at all times borne and will bear
true faith, allegiance, and loyalty to the Constitution and Government of the United States, against all enemies, whether
domestic or foreign. /•,. .a
And I, the said applicant, do hereby constitute and make HEQUEMBOURG fttetL, of St. Louis, Missouri,
my Attorneys in fact and irrevocably, for me, and in my name, to prosecute my said claini and to receive and receipt for the
Certificate of Pension which may be allowed me therefor ; and generally to do all and singular such acts and things as may
be necessary in that behalf.
WITNBS
THE'FOREGOING DECLARATION AND POWER OF ATTORNEY OF-applicant for an Invalid Pension, was sworn to, acknowledged, and subscribed b
and also at the same time and place, personally appeared before me,
me, ^he>lay and y^ar first above written,
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-
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% Certificate No ,r, ' 3 / 7 '|f Pensioner .^^L^^^^L^.
'•j ClasaJIUDQML^E|S,, •' (
i, Date of Death
fV Claimant:
8-E472
L
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* l - ' • • - • - - ' - •« • • * ' . ' . ' .
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IN REPLY REFER TO
Widow Dlv RS. 3~1865
I.C.347479Hannah^Sulliyai£EpARTMENT QF THEratriclc SullivanC 11 Mo. Inf. BUREAU OF P E N S I O N S
WASHINGTON Deo.14,1930.
Mr.Robert S.Sullivan3768 IcCausland Ave.St.Louis,Mo.
Sir;
Relative to your claim for reimbureement in theabove-cited case,you are advised that the enclosedcertificate should be signed by Doctors R.S.Hill andS.H.Reynolds and Helen Sullivan and returned tothis Bureau.
Very respectfully,
«»# Commissioner.JGB WDC.
r
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Ȥ*femuift.
pIP ; '*^^^'^^-Mf^in
^Halte
Very
» P.Billto
W150,
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MEMORANDUM
Maplewood,
S. H. REYNOLDS, B. S., M. D.
191UD
For Professional Services To.
Received Payment,
BILLS RENDERED MONTHLY
Form P-26
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-RICHMOND HEIGHTSST. LOUIS CO., MO..J
HOURS:To 9 A. M. 12-2 and 6-8 P. M,
KINLOCH, MARSHALL 268-RBELL, BENTON 409-L
To Balance ,
To Professional Services
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-#M*
Q&*& *•QJ**Z V
**& I&,?$* f
<**"£ |<M?'fc V.« *r •*oSj? '*astv ":><LfZ "
,_. Jt^ M Ij
If
^ SW "
att it
*%*••<7ifT ;,
* e/- ~*1* II
'• O/
»4>\ \ \J
',', t<3*7f*g>,. og
" ^"2/' -9^., p-C» /»^& ih g7?
" """'» ^ '
ri«^ci[ Vv8!t'tiftw»?w^^»*roLwi«J'*itoM»«^ f^«vnV*~<r
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3—1O81
PENSIONER DROPPED
DEPARTMENT OF THE INTERIOR
BUREAU OF PENSIONS\>o
The Commissioner of Pensions.
Hi-r: • ;,.
/ 'litive I lie, IvOi'ior to report that the, it,a,n/.r>, oj'
Ui-!' aJHrvc-dc-xcri [><>,< I, pt'ii>;-ii,oit,Kr who wan l/int
na,!,l a,l & 3$ ,lo (2^4 • V . /9^« ./- r /'A /
'MM this (Ing lH'fyi/lropw',il lff'oni,ltiw jrul-f- IK:-
Mm*-.
S T L O U I S t] 02 4 7 •'; 7 D M A Y
3500 c i . i v ; ; :;r,:
f
'W I D
Very respectfully,
'<&>&&sUa>&
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3-81O
Claimant
Street and No. _b
Rate, $.: L<?-
Last illness commenced
Last paid t o . - f
f* • •Date of death ..Afe< i-*,..<3a ./i.y.-A;.«.... ^Accrued pension $i.-K: , _____ /:
AMOUNTS CLAIMED.
Physicians' bills _-- - --
Medicine _ -- v -
Board
Nursing and care ~ ~ _ -- --
Rent -
Living expenses for pensioner
Undertaker's bill -~ .
Liverv
OTHER EXPENSES.
-~^y~^
TOTALS ./ _ ..../
$
CHARGESAPPROVED.
f7$ SO
'**-
-? i-S-
^^3
-*-*
^>~<>
DEDUCTIONS.
State aid
Assets
Insurance
TOTAL
$
SUMMARY.
Charges approved
Deductions
Amount approved
X"'
—
^^^ -*-*
f
Approved for
tExaminer, ]{/ Reviewer.
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Courtney, C. Alclrlch,Sec. & Trens.
Laura A. Parker,President.
Orrln B. Laug,Vice President.
WEBSTER GROVESBell, Webster 205
MAPLEWOOIJBell, Benton.31
Casket_
Box
Metallic
Grave Vault
Burial Bobe Underwear and Sundries
Engraving Plate.
Washing and Dressing
Embalming- and Preparing Body
Candalabra and Candles
Flower Auto -
Newspaper Notices _
• Deliveries
Flowers for Door
Chairs
Cremation Charges
BemovaJ Charges _
P 4. ">* ->Outlay for L«*-TMS Grave o-*->. ./rr»-<PTEvergreeiOJlning'F r • " • ' V
Bearers' Gloves
Hearse
~* •• &.funeral ffljrn|sWng:s
Personal Services
^^ /ULMbtso
* &^^QA£^%
~D° —
£> 02 -
s^^
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3—1129
DEPARTMENT OF THE INTERIOR:BUREAU OF PENSIONS I
WASHINGTON
. •Under an act of Congress approved "by the President May ""
from that date is increased to $30 per month
ATTACHED TO YOUR PENSION CERTIFICATE.,/- ^"
•THIS SpIP SH
your pension
BE SECUEELY
Commissioner of Pensions. Secretary of the Interior.
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MF. 14; ' . (808)
The pension accruing from, date of last payment to date .t
pensioner's death in this case ijs 737777: and no
sum is available for reimbursement.
I hereby certify that I hold
•responsible for the payment of any portion of the accrued pension
to which I may be entitled for services rendered, supplies fur-
niched, or money expended during the last sickness and burial of<•» ' v
--•S rrrrrrrt . r- cv TC rrrrrt late a pensioner by certificate! 1 '
-£j£3 (* /-~ ,- "numb er..-^.^^../^ .$•__.
(This.need not .be sworn, t o . )
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ST. AUGUSTINE'S CHURCH,2568': 1EBEKT STREET,
Rev, H. HUKESTEIN, /
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ff
(Attorney,k St..
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(3—128.)
WIDOWS PENSION.
County ^_!A^-^*^&^_._., State
Commencing .-
*-—. per month,
and two dollars a month additional for each child, as follows:
Born, , 18
Sixteen,. , 18
Bom, _. , 18
Sixteen, , ,18
( Born, , 18
( Sixteen, '. , 18
Born, 8
Sixteen, _, 18
Bom, ..^?7C;.^. , 18X5. )
Sixteen,
Born,
Sixteen, _' tK.i. ,
( Born, _., 18
| Sixteen, , 18
( Born, ,18
( Sixteen, , 18
Payments on all former certificates covering any portion of same time to be deducted.
All pension to terminate , 18 , date of
18
18
18
18
, 18/f.
18
18
RECOGNIZED A.TTORNBY:
P . O . . - - - - Articles
A I5 P R O V A L S:
( . '- , origin of Approved for^T??^^^sf8^*a^; death resulted f<Approved for^
—^
kh has been legally accepted,
edical Ecviewer.
Medical Jiejeree.
T IMPORTANT DATES:
Enlisted t -C-:../ } \%&/. || Invalid application filed....^**^^.-/^! , 18//.
Mustered _....>^*3^u<<-:.-- .6 , 18^7. Invalid last paid to ff^^^^:. .., 18
<2fFormer marriage of soldier-.-' ^^r:Discharged
Died
Declaration filed .
Death of former wife , 18' /
Claimant's marriage to soldier.^i
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i
•<*
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(3-562.)
.AOOIR/CJIEID
UNDER SECTION 4718, B. S.
Pensioner, .... . . - ^ r z & ^ c , _________ Certificate No, .
- * ,7 «.o/ death,
^^Claimant, -
V
SUMMARY OF EVIDENCE.
Relationship of claimant to pensioner is shown by
and date of the pensioner's death are shown by -t
APPROVED
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Claimant,
P. 0.,
County,
State,
Attorney,
Rate, <
INVALID PENSION.
Rank,
Company,
•/ yRegiment, 7 ft
per month, commencing
Fee,$
Disabled by
Submitted
Approved for
Discharged
Original application filed
Increase application filed
Pensioned
•f°r $M^^
Claims
Reviewer.
Approved for
,18 ,
V
, Examiner.
Med. Referee.
Certificate surrendered
Last paid at $ , to
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(3-145.)
•*>• INVALID PENSION.
Claimant,.
p. o.,.-Jt',, r^%
State, _.
/Sank, (s
Company,
Regiment,
_/•*"'
'
Kate, per month, commencing
Submitted ftr (^L^L^L-.jLP.i. , 18
^_Approved for . . £ .1 :^?^^^
* //'..r....t 18<?*f. Last paid to ..... -., at
Original declaration filed
/ /^
/ed from .... $:.&&&%'--.£$-•--•, 18W,Arrears allowed
Declaratipn filed ....j£y..Z.£L~Y—t. ..., 18//
f ,
(7280—75,000.)
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'AR Q!F THE REBELLION.i • :. Cf 0 '
INVALID PENSION—ORIGINAL.
Eank, . . r ^
Regiment, .< ...o....5:
1 SERVICE.
,18 , in
Material evidence filed since July 8, 1870.
Discharged (taken from
Eate of pension, $ .per month, from
Declaration filed... , alleging dicdbility
THE ADJUTANT GENERAL REPORTS—
Enlisted,.. ,18 Mustered,...
Transferred to V. R. 0.,.. , 18 ; cause,..
Discharged,
RoU for
j covering date of alleged disability, says: ..f?^~?
, 18
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THE SURGEON GENERAL REPORTS—
Treatment in
The certificate of disability for discharge given by Surgeon, says
,18<££.
PAROL EVIDENCE AS TO ORIGIN OF DISABILITY.
Testimony of commissioned officer,
(filed
Testimony of Comrade
(filed
Ex. Snrg.
Ex. Surg.
MEDICAL EXAMINATIONS.
Finds..
Finds..
\\ Ex. Surg. Finds
Dis.
Dis.
Dis.
,tS.
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Cert !icat« No. Acts of January 25 and March 4,1879.
BRIEF FOR ARREARS OF INVALID PENSION.
Rank,^ ' £x/L=r , Company
VL&*'. 0. addre'ss, / , County lZ/£
Discharged from service ^—rr^.^^LL^.^^^ / . ( / _ _ . _ , 18
Subsequent service from , 18 , to ... 18 .
'^ff
Was first pensioned from.... /.Z^K-..^... ./„</ , 18/^at the rate of $__L.£L_rper month.
Dai:,,
Approved for issue:
• /> x
Arrears of pension due at the rate of $ ^J per month from ^^^^^^LL^L^ L,JL, 180y?
Examiner.
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i (a—111.)-i-
1 Attention is invited to the. outlines of the human skeleton and figure upon the back of thiscertificate, and they should be used whenever it is possible to indicate precisely the location of a disease orinjury, the entrance and exit of a missile, an amputation, etc.
The absence of a member from a session of a board and the reason therefor, if known, and the nameof the absence, must be indorsed upon each certificate.
Insert eharacterfand number ofclaim.
Name a iu.l rankof claimant'.
Q^panv . . ^ .. .... ^-Cluinmiit 'a poaty
^3 address. ^r - - - ^f^y ' (Date of examination.)r 6%
We hereby certify that in compliance with the requirements of the law* we have carefully examined
this applioMfGv'ho,states that he jsjjjufferine frMB-^he follcjwirjg disabjjigj, incurred in the servics, viz:
Cause of d i a a -bility.
e receives a pension of——_—= - . r~/?-- _ dollars per month.if not, erase the ^y \* 4& >y /~^jf^'~7whole line. Pulse rate per minute, .Z-<£L_; respiration,—<^2^i—; temperature,.../^??-—~j height,
feet—y£. inches; weight,— f—^^.y....pounds; age,— -*£.x2—years.
the following sja^ement,u,pon which he bases his claim
^^.^/^^^i^
examination we find the following obj'er jff^r^^T^ ^ sz~^^Z/^/3*£/^—...»_SBT,__ ^C_U ____-_ j< . '
Ki^iis, u i t i uuii- f ^ s i "^jy * ~.^ ~~ f s si
S'!?£^ - ^™^^^^'wnU!11'6 c^^^/^ ^ -*&&'{»>£*-._ S^ -^^/^^^^—t ~£^<^&J^<'^
^
- ,
"
C*TH>^It must be borne yr..fc y1
in mind that *^~iho duty of theSui'geon is to
portionato de-
A c . , through
•yard to dollarsand ccnte, and , -->v>£" sto make such a/^Z S^T^C-full particulardescription aswill afford to-this Office the
ion antl action
ta lftting-
Kate for eae/ tau^ of dUa-
the word note li o u 1 d b eerased uud thereason for theerasure given.
From the existing condition and the history of this claimant, as stated by himself, it is, in our judg-
ment, probable that the disability was incurred in the service as he claims, and tha^itsD &? £r /
not been prolonged or aggravated byvicious habits. He is, in our opinion, en tided to a
for thejjisabilife^aused J?/r : ^ that caused
* See tlie back._J Here state -whether for .ojiginaj, increase, jestoiatioii, or renewaljOr for a re-rating;.
N. B.- -Always forward a certificate of examination whether a disability is found to exist or not.
(6127—100,000.)
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(a—in.) rf
• Attention is invited to the. outlines of the human skeleton and figure upon the back of thiscertificate, and they should be used whenever it is possible to indicate precisely the location of a disease orinjury, the entrance and exit of a missile, an amputation, etc.
The absence of a member from a session of a board and the reason therefor, if known, and the nameof the absentee, must be indorsed upon each certificate.
Insert character!and number ofchiim.
2Jame and rankof claimant.
Cluiniiuit 'scilice address.
-— Pension Claim No..
(Date of examination.)
We hereby certify that in compliance with the requirements of the law* we have carefully examined
this applic£urfO?horstates that h^ js__suffering from-^he following disabjjjg?, incurred in the servics, viz:
Cause of (Haa-bllity.
if not, erase thewhole line.
receives a pension of—_«^ _?~i5l. dollars per month.
Pulse rate per minute, Jf..^...-, respiration,—f^.^i...; temperature,.-^??—-—) height, -.y.
....^f-. inches; weight,— £0^^?....pounds; a.ge,—-^/&2—years. /j f^~^y
kesthe following s>^ement,upcm which he bases his claim for y&r?S^&^ ^^^^^
4 sn examination we fina thp following obeowft-eoriBiJious: .
id dollarsand ccnfa, andto make tmcli afull particulardescription
_ _ _
Bate for eachc»«o of <!«,
"vlckm" Miit?the word no(s h o u 1 '.1 b aerased and thereason for thoerasure given.
From the existing condition and the history of this claimant, as stated by himself, it is, in our judg-
ment, probable that the disability was incurred in the service as he claims, and that^itias
not been prolonged or aggravated by vlpipus habits. He is, in our opinion, entijjed to a_t<2 .^fc?--'?
rating for the disability^aused M- — .1' that'caused
a seer
"See the back.r,\e state whether for original, inciease, jestoration, or renewal, or for a re-rating.
N. B.- -Always forward a certificate of examination whether a disability is found to exist or not.
(6127—100,000.)
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.
SingLwill erfoot of ti
1FICATE
this blank, changing "we" to tead "I," and "our" to read "my.rr They"Sec'y," "Treas.," and "Board" where the words appear, and sign at the'.on the back of the same.
Applicant
State, .: .,U.
V - c 'P. S. Write }ou, PcSi-fffiee adcjress plainly and in full.
PROVIDED FURTHER, -That all examinations shall be thorough and searching, and the certificate con-tain a full description of the physical condition of the claimant at the time, which shall include all thephysical and rational signs and a statement of all the structural changes. [Extract from Section 4, Act ofCongress approved July $15, '
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(3-
EXAMINING SURGEON'S CERTIFICATEIN THE CASE OF AN APPLICANT FOR INCREASE OF PENSION.
G SDBGEON'S AJP»BKSS
t office,....
"/
(ir^^rfy^fr...^^^^/^
*^..&r£4i& ;
-13 g{ fc* sa?
lilt
S P^O^*»
Jttaaina /iom me condition ana fMtoi-u txf we etaitnantj it it) .jfct^y.. opinion
CM inoetHeaf on tfne deivcce CM oiacfneiZj <&nc& tnat it ii net aaaictvafeef oi• f ff
vicious navitA. /?L22y
/{/net tne cWavfaitM CM cweve ctedett&eat,.to. qntittA mim to a ..JTK^^f-'' s f "a ~£f~irJ~/'^ ?
&s £"**'!/ GEji— 's^^^> C^%£ / 5^ Examining Surgeon.
The Surgeon will forward his report of examination direct to the Pension Office wlwther the pensioner is thought to beentitled to increase or not.
•*» >ra<<
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(3-Hfi;)
EXAMINING SURGEON'S CERTIFICATEIN THE CASE OF AN APPLICANT FOR INCREASE OF PENSION,
2
&m tine conation ana /Mto>iu/incctiAea in tme deiw'ce ad ct
e ctaitnant, (X ia .j'aj ana tnat M M not a oi,
The Surgeon will forward his report of examination direct to the Pension Officeentitled to increase or not.
Examining Surgeon,
pensioner is thought lo be
•38
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3 l l f i : )
EXAMINING SURGEON'S CERTIFICATEIN THE CASE OF AN APPLICANT FOR INCREASE OF PENSION,
EXAMINING SUR«BON'S>j)DBESS:
Post office,
County, -"/
State,
Company,
Regiment,
State,Date of examination, _______ f r < _ , , '188
Thatthepresentrating is un-justly low, orthat there hasb e e n ac tua lincrease of thedisability.
^Particular de-scription.
ing for onetwo reasons—that the pres-ent rating isunjustly low,orthat the disa-bility has real-ly incIn eit!the reasons forchanging the
' present ratingishouldbeclear-
afullstatementof the physicaland rationalsigns.
•^ff^-^ e^ <jf^^-^^:^-^^z,^t.
7^^.p . ^^^^k^ . ^ .-v^ .... . ^^-^^ . ^^-
^fer-<?t£-:z££?&&<l£*!6£2 &£:--x:;.-..jtz>£^:.
sS a f e g-^.i••a?*
EH-««
fac/aina /iom me concutiom ana /Mfoiu of me
VCM inowkieat on tne deifies M ctai'mea, a•viciatt;) navifa.
cm a&ove
it M not aaaiavafoa
The Surgeon will forward his report of examination direct to the Pension Officeentitled to increase or not.
Examining Surgeon.pensioner is thought to be
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5
'° SURGEON'S CERTIFICATE
D«fe of Examination i
/? ^
Examining Surgeon,
Post Office, -,-
County,
State, ;_..—.__..
P, S.—Write your Post Office address plain and in full,
|tUi JM.) ELECTRO'S.
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3—O44
APPLICATION FOR REIMBURSEMENT.
(This application, when properly executed before some officer having authority to administer oaths for generalpurposes, should beforwarded, together with the pension certificate and itemized bills of all expenses, to the Commissioner of Pensions, Washington, D. 0.)
STATE OF ________ rn^_^l^il_» __j , ________________ _* -f • «
COUNTY OF ____ .„!/ ___________ /IL_ __ ;--£. ___ ''—_„-:. ...... _____
On this _ ..... -t^t-wZ-/'.l_ ......... ___ day of .._,..,:-<-'. — LJ..i.^.-.i^l.t.-'..f. — , A. D. one thousand nine hundred and. lj,4^**M-3Zv»
personally appeared before me, a"l.i^jLt ___ /,j._jl., ____ s:.ft_.j^_,.,,,__\.,.. ___ _ ______ ..... ..within and for the County and State aforesaid,
^l—Z—.ZLT-'. ! .....i r -i- i , aged ^}3..^2...^. years, a resident of
, County of _X_-'-^..y£^--^~~-~-^~-ijf-' » State of
, who, being duly sworn according to law, makes the following declaration in order
to obtain reimbursement from the aacrued-jension for expenses paid (or obligation incurred) in the last sickness and burial of
jt. l/l__lX^fci^i:t«<££?^^----%J^^ who was a pensioner of the United States by
certificate No. joZ-^.->fcl-j(!.^~-/~----i. °n Account of the service of....—l—^^f/jK^A-------^ 1 u. ,—'-."jf.-r. r.A,-i—» ** f, f --.^ f , . _ „ ^ - JHame otj»ldier oM^lw.Vr /»,, >k.. i _^4 ...... . ^ . .A,- .-.- f ^^ -Z
wcg^by company ami^egpj&ntyqti^ if 4n the Army, or by the words U. S. Nayy, ijjyn the iNftvy.)That pension was last paid t^.AM4f^^A.sM^^^£f^£^i-.-^.., .481' <i£&*!~^-€f / Y Q^- & >
That the answers to questions propounded below are full, complete, and truthful to the best of my knowledge, information,
and belief, and that no evidence necessary to a proper adjustment of all claims against the accrued pension is suppressed or
withheld.
1. What was the full name,of the deceased pensioner? ../lii
2. In what capacity was decedent pensioned? (Asinvalid soldieror sailor, or as a widow, minor child, dependent relative, etc.)
3. If decedent was pensioned as an invalid soldier or sailor— i
(a) Was ne ever married? (Answer yes or no.) ^. • ^
(6) How many times, and to whom?
(c) If married, did his wife survive him? (Answer yes or iKj.)
(d) If so, is she still living? (Answer y«jK>r no.)
(e) If not living, give full names and dates of death of all wives -
(/) Was he ever divorced? (Answer yes.or no.)
If so, is the divorced wife still living? (Answer yes or no, ) ---------------------- ....... ----- (If living, a copy of thedecree of divorce must be filed.)
If not living, give her full name and the date of her death _____ . ................ . ................ '. .......... _______________
4, Did pensioner leave a child under 16 years of age? (Answer yes or no.)
6. Is any such child still living? (Answer yes or no.) — /
6. Were any sick or death benefits paid on pensioner's account? If so, give name of society and amount paid ~t.-~ „. v **
•"" ~ " " ; y7. Was there -insurance (life, accident, or health), in {oroa,,on life of pensioner.at time,,oi death? (Answer yes or no,) ,,
8. If so, give the name of each company in which a policy was carried and the amount in which each policy was written
9. Who was the beneficiary named in each policy?
10. What was the relation of each beneficiary to the pensioner?
11. Were the premiums paid by the deceased pensioner? _
12. If not paid by the deceased pensioner, state the amount of premiums paid by each person who made payment on that
account
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13. Is fcare anlsxecutojf cjj1 administrator, o:r will application be made for appointment of any person as administrator?
doner leave any money,' real estate, or personal property?• „-
15. If so, statetW'dharac^er and value of all such property
i. What was the assessed value.j0agt.assessment) of the real estate?
17. How was the pensioner's property disposed of?
18. Did pensioner leave an uriindorsed pension check? (Answer yes or no.)
19. What was your relation to the deceased pensioner?
20. Are you married? (Answer yes or no.)
22. When did the pensioner's last sickness begin? <^li_lferl£»r^7_-__.<' /
23. From what date did the pensioner become so ill as to require^the^jsegular and daily attendance of another person constantly
until death? .
24. Give tha name and address of each physician who attended the pensioner daring last sickn
26. Where did the pensioner live during last sickness?
27. Where did the pensioner die?
28. When did the pensioner die? jjLr<^z/-?d?,_^»Z_.
29. Where was the pensioner buried?
30. Has there been paid, or will application be made for pa^sSfeut to you or any other person, any part o'f the expenses of the
81. State below the expenses of the pensioner's last sickness and burial. Write the word none where no charge is made incase of any item of expense noted.
(Each charge entered below should be supported by an itemized bill of the person who rendered the service or furnishedsiny supplies for which reimbursement is demanded, and should show, over his signature, by whom paid, or who is heldresponsible for payment, and contain the name of the pensioner for whom the expense was incurred or service rendered.)
STATE WHETHER PAIDOR UNPAID.
Physician .
Medicine
Nursing and care
Undertaker
Livery
Cemetery
Other expenses and their nature
f
32. Is the above a complete list of all the expenses of the last siekness and burial of the
deceased pensioner? (Answer yes or no. ) ------- !ZZ3?~^~- ------ )- ..... ^g .n ,-*» -I'/ O (- ~/MS <(* * J* *.£' *»£*-{
That my post-office addresa,is No.-^V... /..(£>..&- _______ , on ____ ./J ...V..S:«4-«^a«*8l!rS!S*ri<S_ ................ _. street,'(T"V^ r^ '
town or city of .....Jfe r.A^J^**s*d?..- .......... - ..... ----------------- , County of .
'State of.. _____(When the claimant for reimbursement is a married woman, she is_ required to sign the application with her own full
name, not using the Christian name or the initials of her husband, and all bills should' foe ..receipted to her in herjuyn name.)
(Claimant's signature in full.)
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1, , the claimant, sign"who, being duly sworn, say that they saw.yL?*^
name""*;/(or make _, : mark) to this application; that they know the claimant herein and that their answers to the
following questions are true:
1. Did pensioner (if a soldier or Bailor) leave a widow or a minor child under age of sixteen years surviving?
, « . . . , .2. When did the pensioner die? ^ ^i._-__-- -.
3. Did pensioner leave any property? If so, state its character and value,.
4. We knew, pensioner Jj. years. W^ believe above statements to b,e tmal-because _.
Name -j!-"__ ,. , , Name —iji-'r^ix
P. 0. Address , . ' '" P. O. Address ._Z ..2./l ../*S i-i-Y--f.-..*.k."fc>-.*-<
Subscribed and sworn to before me, this -^L.efeTL. day of .-i-liu.-.gfcr-. j.j- . i.». '—-
A. D. 19jtjSt; and I certify that the contents of the foregoing application were fully made known and explained to'the
claimant and witnesses before swearing, that I have no interest, direct or indirect, in the prosecution of this claim, and I
further certify that the reputation for credibility of the witnesses whose signatures appear above is _._ „'.
STATEMENT OF ATTENDING PHYSICIANS.
Give dapJrof the pensioner's death
!0(fve date of commencement of pensioner's last sickness './J3.
From what date^ did the pensioner require the regular and daily attendance of 'another person constantly unfctl death?
^/£*/?*^
During what period did y$i attend the pensioner 7"s&!*!
State nature of disease from which pensioner died _•
Give name of each person who rendered aarvicoAs nurse, and who has made or will make a charge for s,uch service...
«i
Give name of any other ghysjcian who attended the pensioner in last sickness ...... _____ _•_
jDoes your bill include a charge ffi all medicine furnished the pensioner during last sickness ? .C^
Has your bill been -gaid ; if so, by whom? ________ jQ3£«^_. fe-*»!tf-<x::3!**«t
Mention any other facts within your knowledge which in your opinion would be helpful in adjusting this claim for reimbursement:
?X3&---J£»^4*^^^J&.7 / ? /. t
I certify that the foregoing statement is correct.
6—1572
ttending Plwsin
Attending Physician.-., 191
MiL
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' t ' 1 ' « i« M 0 H > 0
*<g *> s &aa g g eL*^ft||s s 3"i! Si sro f»!§.B'S*t° B tt'&l?'8:l w ^ SS ffl 1S " «•"'•• «l' 4l:s4fe iw§*aa«i?s,?.:T i
' - !
§
0
The Act March a, 1895 (28 Stat. L., 964), provides— /*That from and after the twenty-eighth day of Sep.tember, eighteen hundred and ninety-two, the accrued pension to the
date'.of the death of any pensioner, or ofany person entitled to a pension having an application therefor pending, and whethera certificate therefor 'shall issue prior or subsequent to the death of such person, shall, in the case of a person pensioned, orapplying for pension, on account of his disabilities or service, be paid, first, to his widow; second, if there is no widow, to hischild or children under the age of sixteen years at his death; third, in a case of a widow, to her minor Children under the ageof sixteen years at her death. Such accrued pension shall not be considered a partof the assets of the estate of such deceasedperson nor be liable for the payment of the debts of said estate in any case whatsoever, but shall inure to the sole and exclusivebenefit of the widow or children. And if no widow or child survive such pensioner, and in the case of his last surviving childwho was'BUchT'minar at hjs death, and^in case of a dependent mother, father, sister, or brother, no payment whatsoever of their
^ttWrtiTOof their last sickness and burial, if they did not leave sufficient assets to meet such expense.
The Act March 3, 1905 (33 Stat. L., 1169), provides—* * * and no part of any accrued pension shall hereafter be used to reimburse any State, county, or municipal corpo-
ration for expenses incurred by such State, county, or municipal corporation under State law for expenses of the last sickness *or burial of a deceased pensioner. ' ,
INSTRUCTIONS.
1. Accrued pension is not a part of the assets of the estate of a deceased pensioner, nor liable for the payment of the debts •of such pensioner.
2. Accrued pension is not payable as reimbursement in the case of a person pensioned en account of service if a widow orminor child under sixteen years of age survive.
„», 3. Accrued pension is not payable as reimbursement in the case of any pensioner who left sufficient assets to meet the,*,,!***expense of last sickness and burial.
4. Application for reimbursement should be accompanied by the following evidence:(a) Bills of all expenses of last sickness and burial. If paid by the claimant for reimbursement the bills must be
properly receipted to said claimant; but if paid in part only the creditor should state by whom paid or from what sourcesucn payment was received. If unpaid, the parties to whom said bills are due should note on each bill, over theirsignatures, that they hold the claimant responsible for the payment. If the bill be for medical treatment it must showthe dates of visits or treatment and the charge for each. A bill for nursing and care must show the dates betweenwhich the services were rendered, and the rate per day or week. The bill of the undertaker must be itemized, andshow the date on which the services were rendered.
• Each bill musfcshow that the service was rendered for the pensioner on account of whom reimbursement is claimed.All claims should be presented in the name of one person.Bills'which are forwarded become a part of the-recordsof the Bureau of Pensions and can not be returned. Claim-
ants should therefore secure duplicates of such bills if needed by'them.-(6) The pension certificate which was, issued in the name of the pensioner. If such certificate is not in possession of the
claimant a statement showing its whereabouts or final disposition should be made.5. A careful compliance with these instructions will save much unnecessary delay in the settlement of the claim presented.
NOTICE.The only sum available for payment of a claim presented on this blank is the pension unpaid at the date
of the pensioner's death. 6—1672
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£2g^«=£3SL..-., 00:
v. 188 0; personally appeared before meON THIS J .-.C:...... day of
in the County ofi- r±Z^..-r^.- rrTTT. :.:: and State
Post Office address is ...-.C--.;....rrrrr. _ „
well known to me to be reputable and entitled to credit, and who, being duly sworn, declared in relation to aforesaid case
as follows:
.—Affiants should state how they gain a 'knowledge of the facts to which they testify.]
further declare that-&^rrTJ^!??rr5*^^^no interest in said case and <?s?:#^T&!=rr__not concerned
its prosecution.
(If Affiants _jign by mark, two wftnease
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• tjw'' above-ifamed affiant , and I certify, that I read said affidavit "to said
- erased, and the words
•TV,;.- .....'j.-.-i-, added
'and acquainted---;^T^.*l*'S-'— ...with its contents before.— /tx~^_—executed the same. I further certify that I am in
nowise interested in said case, nor am l-concerned in its prosecution; and that said affiant T^^:.. — personally known
to me and that.~'?^?SrC.'r —...s*?s-—. credible person.
I, - — Clerk of the Counw Court inland for aforesaid
and State,'1 certify that— , Esq,., whofcas Bignea-bia5|toe,to the
foregoing declaration and affidavit was at the time of so doing - in and
for said County and State, duly commissioned and sworn; that all his official acts are entitled to full faith and credit, and
that his signature thereunto is genuine.
Witness my hand and seal of office, this—.— day of , 188
[L. 8.] Clerk of the
NOTE.—Th'is should,,be sworn to before a CLERK OF COURT, NOTARY PUBLIC or JU3TICE OP THE PEACE.If before a JUSTICE or NOTARY, then CLERK OF COUNTY COURT must add his certificate of character hereon, andnot on a separate slip of paper.
![Page 66: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/66.jpg)
o
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/£>•/7
! f/
<^^—~
...i
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w
rr? '
r-^-^inyvi^j TW xi
077 y^/ -
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*OM 'smo'i6T©
lu!EIO
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![Page 70: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/70.jpg)
.S6S-PH YS'J.01 &.N8 , OUT. THESE ,
Certificate must be 'fully and;accurately filled out, or,it will not be received and signed,°®«
of Deceased: ^..^...^...
Years, Months,
Cross ouf the words not required.
Place of Birth .
Place of Death .ii££...**f&*..<f...t.
Date of Death*.
Cause of Death..
•I CERTIFY that I attended the person above named in.,
the disease stated, on the date above named.
last illness, who died of
M. D.
| Place of Burial^.....:.
Undertaker.
i OFFICE HEALTH DEPARTMENT,
St. Louis, Mo., 188
I CEETIE7;:that"I have examined this Certificate, and find it to accord with the requirements of the City
Ordinances and Charter and the Mules of the Health Department.
Health Commissioner.
Clerk tt Eaalth Commissioner and Boird it Health.
vided by Ordinance No.110J329.
receiving Burial Certificates without the signature of/he Commissioner or his Cleric, will subject themselves to a.fine, as pr
* In filling out thevabove Certificate -Physicians are e. ,ested to conform strictly to the Nomenclature printed on the back.
ir
.J
![Page 71: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/71.jpg)
4N
1\J
sg<£ft
*K>
*n•S<»
"K>«3«SSiPs
6o.-S-:so-K>£8•i<.o
•K>**>
^sV
>
1
NOMENclATOR^^fr-l^Mfe.'^X • .OLA-ss i.
SYMOT1C. "1
ORDER 1.— Miasmatic.
Diarrhcea
Dysentery
f Entero-Colitis
1 Erysipelas
' Group., ,
1 Diphtheria
Tonsilitis
Fever, Bilious
" Cerebro-Spinal....
" Congestive.
" Hectic
" I ittent '
" Eemittent
" Scarlet
" Typhoid
" Typhus
Measles
Pyaemia
Septicaemia
Toxaemia
\a
Variola
• Varioloid
Whooping Cough
ORDER 2. — Enthetic or Inocu-lated.
Malignant Pustule
Alcoholism j ManKrpotue:
Inanition. ;
Purpura Itemorrhagica
'i* ORDER 4;— Bcfrosttie.
Tsenia
Vermes
' j <' 'Vat
"\» QmeA f.—biatlietic." A < r-~~^Anaemia , t. .T^Ti
" Breast -iVlAJ}
'* Intestines
" Ovary,
-
ORDER 2,— Tubercular.
Abscess Lumbar
Gangrene
Hydrocephalus
" (Chronic)
Phthisis Pulmo.mUis
Scrofula
Tabes Mesenterica
TubeicularBionchitis
•' Enteritis
" Laryngitis
" Meningitis
" Peritonitis
OL.A.J3S 3.
LOCAL.
-ORDER I,— Nervous.
Atrophy (Spinal) ;......
Apoplexy, Cerebral
Apoplexy
Congestion of Brain
Epilepsy
Inflammation of Brain
"• Cerebro-Spinal
Myelitis1
Hemiplegia
Chorea
Softening Of Brain
jjrr f f •*** F
^T3Bft(Wi?^!fcn4a<orj/. i C
An*gina^Pectoris|.!.,. <
Aneurism'..'.'. f...^..* <..
D@ |fW^}-|«v
Embolism (Cerebral) .* ,
Endocarditis
Fatty Degeneration of Heart-
Heart- Clot r,....Hypertrophy of Heart
Thrombosis, (Pulmonary)
Valvular Disease of Heart
ORDER 3,-~Respiratory.
Bronchitis
Hydrothorax
" (Typhoid)
ORDER 4. — J'igeative.
Ascites., „
Colic (Bilious)
Enteritis, Chronic
Gastro-Enteritis
Gastritis
Peritonitis
Fatty Degeneration of Liver..
Hepatitis
ORDER 5i-^~Urinai'y.
Cystitis
Diabetes Mellitus ;..„. ,
f '», ''" f * i J\ t\ 1, 1 *
,, P^ostatiiis.....,..",. i^m^i
ifrajmia'..^..^..!'., V(A,.^
^ Oto'^JSntfte.0.
^ , J *' * ^ ' M
Metro-Peritonitis (not Puer-
Ovarian Tumor u
. Ovaritis ,.
Uterine Tumor ,..
ORDER 7.— LocomotoryOsseous.
'
Lordosis (Cervical)
/ ^ORDER 8.— Locomotonf^lfnte^^mentary.. *jjr4
''/' * ^
Carbuncle,. ..Ig... , C.".»
Cellulitis .X ^rf....Xy " *"»
Eczema (Impetfgmodes) ^
, P ( >l **"'•" .
DEVELOPMENTAL.
ORDER 1.-^- Children.
Congenital Debility
Haemorrhage (Umbilical)
ORDER 2. — Women.
Chlorosis
"/ i " (Vomiting)
' Puerperal Convulsions
'1 ) ketritJs..^......;
'*,-. /Peritonitis
" "\ Septiceemia
Exhaustion i from TediousLabor SL .".»
v "
, ORDER 3.— Olc/f&ge. .
f Gangrene (Senile) 1
OEDER 4.— Nutrition.
Asthenia
Atrophy >.... .'
CL-A.SS 5.
;k VIOLENCE.i^T >
k OKDE^R 3 .— Violent Deaths.
Drow'ned ^Ac^dental)
filled by.Lightning.
'*• poisoned by
Shock from
Suffocation (Accidental).......
C }
ORDER 3.— Suicide.
Suicide by
Poisoning
Gunshot....
Drowning
Cause not ascertained
Total
Stillborn
Premature Birth
![Page 72: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/72.jpg)
' ' ( • ' I " '/ V- . JU'fw-is v
,A. D. 188 personally
,—,,.,..' '.'.........:"...Ci in and for the aforesaid Qefaxty duly authorized to administer oaths
aged.~C*ifiV-»—years, a resident of
i^ the '
whose Post''Office address -is'..
a. aged -i —years, a resident of-
in the County of---"--—™., ——-— • —----- —.and State of—-
whose Post Office address is?
well known to me to be reputable and entitled to credit, and who, being duly sworn, declared in relation to aforesaid case
as follows:
OTE.—Affiants should state liow they gain a knowledge of the facts to which they testify.]
>?%> .. .<=^^^^
:i .:..f ^tfg>- <^5i>-Z^:
n/ sy ,c / /
.&3^
no interest in said case and
![Page 73: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/73.jpg)
AD
DIT
ION
AL
E
V-I
DE
NC
E.
Pri
nted
and
for
sal
e by
J.
H. S
Otr
tti;
Was
hing
ton.
D.C
.
![Page 74: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/74.jpg)
1 / 4 '' |J., f /EAJCE1 J
*f davit is, prepared from1 inemojr-knda i
t* ML * " ' ' "
0tdte of-.
Hi-;.- i -••^WAVi" V * > * ' '^t v
^^ . Pip-fUK' .' - f ", |t^y*hand,wfitmg^f ''thjs' afflafityihe marginal instructionsi-'1 ^l^beffaplip 'injpossgSaio'i, of aiffi'ant as to the oragin andief'dalj'es'of Ij,tr!ea|m6nt'1sh;c)-gld«b0.l'spe6ifi6ally g|ven. If the affl-
^ •;, !-•*' %<,;•' ' i»'<,,*;la" ' •'.^i<y$.',lV\>-' {;
off-.
In the Pension Claim No.--
(pompany and regiment of service, iMn the army; and rank il In tne navy.)' , t I', *
,, 4-VS,V.f5 ' ' ' ' " ; ' X>^ "V ' ', ii » ' ^ <Sf-^ ' 4 'S ' t"' (' ' '
Mp'>". , !'"' Per^lljy came;,befpre me,a,....-~:. £l :!^^ f6r the
»/«*'/'•"
whose;PostiO%ief^Jiaii»es^ is-
well known to; me to1 be reputable and entitled to credit, and who, being duly sworn, declares in relation to aforesaid case
as follows:
That he is a Practicing Physician, and that he has been acquainted with said soldier for about — X-- ------ years, and thatt — X-- ------
(Here embody all the fapts known to the affiant In accordance with the marginal instructions. No erasures or interlineations will be permitted" * x?" X t
unless the magistrate certiaes in ms jurat that they were^made before executing the paper/
of - obsphysical ooiwitiwhether as'lfamily physician oras a neighbor; andhow near he haslived >to him. Ifhe knew that thesoldier was a soundmam at enlistment,he should so state.adding, if true,thathad he" been un-soun<l,have known it.
If he treatedclaimant while inthe seivioe either'as hid regimentalsurgeon or while
"olainiant was homeon 'furlough, thatfact should bestated. Tbeolatta-ant's physicalcondition top suchtimes'shoula'.'beclearlOf HI0
" and'date? ofytwat-' ment
![Page 75: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/75.jpg)
He further declares that he has been a practitioner of medicine for f&G&**?^. years, and that he has no
interest, either direct or indirect, in the prosecution of this claim.
(Affiant's Signature. Give rank and service, if in the army.)
Sworn to and subscribed before me this ...... ....^"... ............... day of ........ . ' ^ i f f f ^ i f - ............................................ A. D. 188 S2-/ x
and I hereby certify that the affiant is a practicing physician in good professional standing; that the
contents of the above declaration, &c., were fully made known to him before swearing, meteding tho wejds
.ad^ed; ..and that I have no interest, direct or indirect, in the
prosecution of thi
W&f
,'
(Official Signature.)
••—V,
, ,,, ..,.,11, , ct•. '*•,-• ' v« . l ' (" '» !>
,' " : t* -li > ! '
(gMoial Character.)
./- .. Clerk of the County Court in and for aforesaid County
and State, do certify that , Esq., who has signed his name to the
foregoing declaration and affidavit was at the time of so doing—— - ; in and
for said County and State, duly commissioned and sworn; that all his official acts are entitled to full faith and credit, and
that his signature thereunto is genuine.
Witness my hand and seal oi office, this—... .'day of , 188
[L- S.] Clerk of the
, NOTE.—This should be Sworn to toef6re a CLERK 'Sp COURT," NOTARY' PUBLIC oV'trUSTICE OF THE PEACE.If before a JUSTICE or NOTARY, then CLERK OF COUNTY COURT must add his certificate of character hereon, andnot on a separatetslip of-;paper. • '
. s, N * J t*« <ws$W#**< > *i»U»! • *
uwQ
U
w7 ';
fiM
£• S'
, B
Si
S
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£&_..; %rtttjt8?<j;
.iJsSSarifeS t t* ';,
* > - i ,. D. ISS^personally appeared before me 'j ' ' , , / „ , ON THIS
fa . in and for the aforesaid BtiuiLliy duly authorized to' administer oaths,
-S-aged— rtdsaat-years, a resident <^^^^f^S^^^..,.!^r^....^.!r^^-^. i \
,',- i*"'Vl
in the County of'-*° -.-T: - and State of .-
\\hoso Post Office address is ,-•
well known to me to be reputable and entitled to credit, and who, being duly sworn, declared in relation to aforesaid case
as follows:
V^.^ _^NOTE.—Affiants should state liow they gain a knowledge of the facts to whioh they te
ix2£g!2£fe ^^^..,.^^^^'., ii j h 'r ^ ' ' ^ '.f T . > ' , ' ^ . < ri \
"-"y . ~~'.3t ~«* - -^ez*a
x... ".<^ 4 si. L r... ^
i 1 I 1, /1 v . /7^ ^/ .
tp prosecution, , 5>_ , < j ;< i? \
..!'V fSfrlt?'!' , > , , / , , < " ' , ' i\J - ' > ' , ' / ' , - ; " . * * ! ' ' ' -T^ ' • H''
![Page 77: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/77.jpg)
AD
DIT
ION
AL
EV
IDE
NC
E.
Pri
nted
and
for
sal
e by
J-
BC. S
OU
tE, "
Was
hing
ton.
B.C
.
2 H
ri
"
s"
D"^ Sg fe?
Ho §1 8^ ch£>
^ v
^
^8 cT«
§gif 1% s? ay fS 1§ KO B
)t1 i
s li 2«
tr-f
fiCD
fej fa go
!.«
P DO
S' I B I
Q
I o
Q o p* £' o g- S
o
05 I'
ff? P<
r+-
1—i
O P I Pi
P.
5 f P I
-y-.;
-^ig
,;-j
iL...
![Page 78: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/78.jpg)
Widow's/ Declaration;
i must be Executed before ^ouri' o;
; Pension 'or Increase of Pension. '
Record or some Officer thereof having' Custody, of the Seal.1
, 00:StateON THIS day of. ...C/.&f&CZ^t&ttl. ................. _ ........ A. D. one thousand eight hundred and ei
personally appeared before me -CW?-Afe?^x ...................................................... of
of Record within and for the- towand State aforesaid
_.Q ,aged ....^}....O , years, who, being duly sworn according to law, makes the following declaration in order to obtain the/
Pensjon provided by Acts of Congress granting pension to widows: That she is the widow of.. /"x^ ^/szsy^—/^
/- /^ ~~1? /^.., •tfaokfrl.^£.&?.££.-..under the name
^...^^^Jf^^...ff^f^^^^.^...^....^.^...^ , oi^the /.^y^^dayj^ -sfZ^Z- ^f? _ / „ (["_ „ ; -?
in ../.^__C2..-(Company and Regiment of service, if^n the 5-erressel and rank if in the navy.)
in the war of Z..4Z .<... ..rrZT~../:...£L..«S..eJ who(State nature of wounds and all circumstances attending them, or the
i and mamier in which it was Incurred, in either case showing soldier's death to have been the sequ- ' v . , ,^ ~
on the
who bore at the time of his death the rank of( I n the service aforesaid." or otherwise.)
...to Said.....rrb?^<^>^^2:c^that she was married under the
on the r^~..,..^r. day of
ere being no legal
barrier to such marriage; that neither she nor her husband had been previously married(If either have been previously married, so state.
and give date of death or divorce of former spouse.
that she has to present date remained his widow; that the following are the names and dates of birth of all his legitimatechildren yet surviving who were under sixteen years of age at father's death, viz:
of soldier by .C^ r ?^?;r»se2 fe rS«rrr..., born.^A£--^~-~/--~-- 18
if soldier by .tjf. (/.. , born ..£c ^^.of soldier by J\ b6rn ..18
of soldier by. . 1 , born J\8
of soldier by .A,. , born :l.---.... f.-=iv. L_.,...:. 18
of soldier by.. , J i..... , born __X— 18
. of soldier by.. ':..... , born \8
That she has not abandoned the support of any one of her children, but that they are still under her care or maintenance.
(For such children as are not under her care claimant should account.)
that she has not in any manner engaged in, or aided or abetted, the rebellion in the United States; that.....?.!!IZ^2r rj? '!" ~:
S /s? ^ ~">f^ ^*/s S* ^ ^/^ ^"*^ Sj's?
prior application has been filed £%^-<££^???Z^^^(If prior application has been filed, either by soldier or widow, so state, giving number assigned to it.)
: .,.y (..j£,g2?./
that she hereby appoints with full power of substitution and revocation,
her attorney to prosecute the above claim; that l|)(ff residence is
and her'Post Offldb'address is
,(Two witnesses who.ci
![Page 79: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/79.jpg)
Also personally appeared..;J
residing &l..c&..<&&.^..-'&&f<(<d4f3<**ttrf. yy/(A£&?7TT. .persons whom I certify to be
/fan ~~f"—raspectable and entitled to credit, and who, being by me fiiiiy'swOfn, say that they" were preient and saw -./OOrf5£2T^&*£^t<l-.
IS&L). '.., the claimant sign her name (mafre-'hcr mark) to the foregoing
declaration; that they have every reason to believe fro-m the appe'arance of said claimant and their acquaintance with her that
she is the identical rjerson she represents herself to be ; and that-they have no-interest in .the prosecutioni :0f this claim,- • •>.-• •; •
(If Affiants sign by mart, two persons who Can write"sign here.) - : '3t*??kZr%d*<^t,...<Z?^^
" ' • (Signature o f Affiants.)
[L. 8.]
Sworn to and subscribed before me this.y«l5*£.~"^_\.—......day 6t.^.&&&T~z^&???4/^..... A. D. 188<fT..,
and I hereby certify that the contents of the above declaration, &c., were fally made known and explained to
the applicant and witnesses before swearing, including the words t _.^
..erased, and the words.,
prosecution of this claim..
...added; and that I havW n'6 interest, direct or indirect in the
0fl-H
O)-H
CO
WS
'04
![Page 80: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/80.jpg)
GENERAL
p"
, 00:State of &J^L#^<xi*6*t. __. , Couritg of-In the matter of,.
ON THIS ....... « . . ..................... day of A. I). 188?"; personally appeared before me
in and for the aforesaid Coxinty duly authorized to administer oatns,
. 9aged S*-ff~ years, a resident of .•J?£^^^ifiilf^-2^^^^^i
'in the County of' .<^^rffe.--^s^te^ii?!'. ..... ~ ......... ........... and State of
well known to me to be reputable and entitled to oi'edit, and who, being duly sworn, declared in relation to aforesaid cuseas follows:
[NOTE.—Affiants should state lio»?r they gain & knowledge of then*trts to whioh'they testify.]y/?
^JQ.O interest in said case and - rl!?f!T*^Vrr3*it!r-..;..not concerned
in its prosecution.
(It Affiants sign by mark, two persons who can write siftn here.
![Page 81: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/81.jpg)
Prin
ted
and
for s
ale
by J
- H
. SO
PtB
, W
ashi
ngto
n, D
. 0.
I I
li
Eh
so o
cc t-3 I o
![Page 82: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/82.jpg)
(3-56O.)
APPLICATION FOR ACCRUED PENSION.(WIDOWS.)
^Olinifl OjJ&J&£3^&-.rte-&r£<^&_____, Ss:
clay Qi ....^^f^.^^pf. , 188^personally appeared
-., "who, being duly sworn, declares that she is the lawful widow of
., deceased; that he died on the ^ferr. dayc~ i x- f~V v^7 ,s\ y~ /*>
of .^-^^fdAdd^^U/IA^^ is./J.; that he had been granted a pension by Certificate Fo. Zx^«-^l £_-£_.I i ~t/ ./ &, -^J ' •—?*- *./ ^which^rs herewith returned (or if not, state why not) ..^^...tfT^jZ^.t^^^fc^ —'
; that he had been paid the pension by the Pension
Agent at,/.t/^^.LA2/._/.L-^'^-----. up to the .___>#—— day of\_s
after which date he had not been employed or paid in the Army, Navy, or Marine service of the United
StateSiNkeajp^t- ^ /- •?- ; thatJb /t(, S/? ' // J?
she was, married to the said ^<^.-^>^^^.A^r^.<^i-ri^r^C~^?2t^-..on the ^v.<f^^^7^^-.— ^»^
in the State of/
.; that her name before said marriage was ..j^*?^f^S^f^:^.^
..; that shei»^^ had not) been previously married; that her husband
3 hacFnot) been previously married; that she hereby makes application for the pension which had
accrued on aforesaid certificate to the date of death; and that her residence^is No
street, -City of.-"—.- '—r',-V-': ., County of.
of.._^.^2^^^t^3e^^^ef. , and her Post-office address is
, State
/
/ $ /V"Mow's signature:) ^(/C/(^7^^7 <3^ ~4J/i^C™^' j5«^?tT-
. (/ - ,-?' / " >x // , JS ' /
Also personally appeared ..^.{£^^^u^^^^/^^^SL£^9-fffj^, residing at ^Q^-^h^-^^T'^J£ ( // *r/ ' s
.., andv37?!g?i?5?^2<^---<r^-<~<*-?r±fi2^ at
^ who, being duly sworn, say that they were present and saw
.sign heE-aaine-(inakc her marls)-to the foregoing declaration;
that they know her to be the lawful widaw of !ti_^<?L/L /.&^J^5^^ , who died
on the .-.../f-frp^. day of If^d^Ad^Q^^l.^ 1S<Q._; and that their means of knowledge
that said parties were husband and vrifg, and that the husband died on said date, are as follows:
.^^S3^^!l^£^^ ^^^,-. x y / S /^ ,t—^ ' /^ x s? , 7
. Sworn to and subscribed before me on this .^..-^—f. day of.
and I certify that the affiants are reputable persons; that they know the contents of their depositions, and
that their statements are entitled to full faith and credit. I further certify that I have no interest, direct
or indirect, in the above claim. "' ' "'•
(Signature:)
3:t—5M.)
(Ojfieial character:)
c
![Page 83: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/83.jpg)
APPL
ICAT
ION
FOR
ACCR
UED
PENS
ION,
—
(WID
OW
S.)
Cer
tific
ate
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&
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eC
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f ,
State
.^AFFIDAVIT.^=fc
ON THIS
' < * " • # ' *..... :(3<*«*5SS5r. ...... <••*&
j <Zi—/ /"// / *r/ ....„...! day of... ^K^^k^^- L A. D. 188 y\y appeared before me
r.; < ,,in and for the aforesaid County duly authorized to administer oaths,
||l::;
2fe;f!W*3^.,..j«£*^.^J^!C^.:?ir^h aged ..«?i.i . years, a resident of c
in the County of ,_^ rss£r 2>sfe*s?'. and State of
whose Post Office address isX
aged
in the County of jc^r*- o^j^-z^z^isz? and State of
years, a resident of: .e^^^r.,^^f^^<^r^^:.
whose Post Office address is^j^^Tj^-fet^TT.^^X
well known to me to be reputable and entitled to credit, and who, being duly .sworn, declared in relation, to aforesaid case as
follows:
[NOTE—Affiants should state how they gain a knowledge of the facts to which they testify.]i
's^jt^r.f
H' fv
further declare that.
..no interest in said case and
its prosecution.
not concerned in
Affiants slffri b^mark, two persons who can write si^n here.)
![Page 85: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/85.jpg)
STATE or <s>^^^^< ...<fexf*fesfefe....,v. ......i.J , COUNTY OP .,r | I f r
Sworn to and subscribed before* me this day by the above nanjed affiant , and I certify that I read said affidavit to said
, , _ '. added
and acquainted ..../*?&frKt' ......... with its contents1hefore.,.—^Z4ii<'. ................ executed the same. I further certify that I am in
nowise Interested in said case, nor am I concerned in its prosecution ; and that said affiant.^ ..... '3x3<<€.- .......... personally known
to me and tha.t..j&>(.....4&ttZ. ........... credible person.^
(Offiflfal Character.)
I,.. ,.J?,.Z.-n., .: ,U , .,./...,/...<Srr. r .c,..r±r :±^- Clerk of the County Court in and for aforesaid County
and State, do certify that ^LJ.^^^^r^:!?.. ^.^^^d^^,, , Esq., who has signed his name to the
in and
for said County and State, duly commissioned and sworn ; that all his official acts are entitled to full faith and credit, and that
his signature thereunto is genuine. ^—
foregoing declaration and affidavit was at the time of so doing - - fr^^ ." ....?fi£T*TV'... .._(?^~~^*~~*--*—~€—' jt;
[L. S.]
Witness my hand and seal of office, this h^ day of.
Clerk of the
NOTE.—This should be sworn to before a CLERK OF COURT, NOTARY PUBLIC or'JUSTICE. OF THE PEACE.If before a JUSTICE or NOTARY, then CLERK OF COUNTY COURT must odd his certificate of character hereon, andnot on a separate slip of paper.
Kf-Wfl
oaaQ$W
zoIf*h>—IQ
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GENERAL: AFFIDAVIT.
State of
In the matter of W-ML0tCtft tg*. "&*
of ., 00
ON THIS / day of . ..A. D. 188 5f personally appeared before me
in and for the aforesaid County duly authorized to administer oatha,
.saged .years, a resident of.....^fZtJrr-?r^^2-..<^rr-^rr^T^?T
ih the County of ^cfess^tz-^fes?. - and State Of
well known to me to be reputable, and .entitled to credit, and who, being duly sworn, declared in relation to aforesaid case
as follows: (2- %,,st ^ «Jr
[Nora—AfRants uld state ho^? the^ata a kjit6wleage of the facts to %Jiibh they testify.]
' £**<—£- e-^&t.
Post Office address is.i
.further declare that
ita .prosecution.
u
[If Affiants sign by mark, two persons;who can write sign here.] [Signatur
![Page 87: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/87.jpg)
AD
DIT
ION
AL
E
VID
EN
CE
.
FIL
ED
B
Y/
Prin
ted
and
tar
sale
by
J. T
i, 8O
UL
K,
Was
hing
ton,
D. C
.
I: oo
c!^
X OH
d ~td
K' g o O
2 5- o
§0 g1^
" 1
-3
IS
"
S B •O.
o »-<5 O
I g o B i a p B P-
g. ffi
Et B o B 05
1! !!
![Page 88: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/88.jpg)
ACT OF MARCH 3, 1883.
INCREASE OF INVALID PENSION.
•Rank,
Company,
Regiment,
Attorney not recognized. JVo fee payable.
Rate, $24: per month, commencing March 3, 1883.
. . v / ^Disabled
Resulting in total disability, such iia to'rander
Submitted ..... , 1883, ly eJ...¥.S£.f./3^Jfc{j^.. ..... ... Examiner.
Approved.. .............. '. ____________ ...... . ............... r r ~ r r r ^ r f c r ...... _______________ , Reviewer.
A C T AUGUST 4,1686
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IV
8"
8
4
v^ ^
\
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-s&2*&&c*j**L.
^4
s£j^
.-(-^>
S S /
-£3££tyc£e&
~&*^te.J..£-..£&e*L.^£~
'4£**j(.g..j2e e^*^^/<£-</v-~xs5^ f^L**CJ& ,
<^^.- ffc&t^fl^??r4^? &L~ -/&3^t>
&btsfr 0djrl^£cSl>t4- .*-
P'
R. ,p. DRUM,Adjutant General,. '
Adjutant Senegal.J (a) /
'X1
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![Page 92: Patrick Sullivan Civil War Pension File](https://reader034.fdocuments.us/reader034/viewer/2022051519/577cc7991a28aba711a16f05/html5/thumbnails/92.jpg)
fr-
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c
'CASE OF AN OBIG-INAL APPLICANT.
No. of Application, /£>f/
Applicant's serVice.
en Me teivice o,
tnva
'ate£, w-fio (4 an APPUCANT/• / J • / / / / / / ' /'#',nv-aua neiMion} fat ieaton of atteaed awafoMw i&utuina ifiom
/
Degree of disa-bility.
Origin.
"Probable dura-tion.
Particular do-fioription.
4at'a
tncafiacitalea /o./e caade avove
/' S' / /' •om fi(4 nietent conaw<?on, a
ifaoaui'P aetciififoon o e attcanfo con
/ comMeaton,
9 /
r Examining Surgeon
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1 URGEON'SrCEETIFIOATE 1
CASE
Co? ., Reg't,.
A P P L I C A T I O N F O R P E N S I O N .
No. „../.
BATE OF EXAMINATION,
Mxamining Surgeon.
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RECORD AND PENSION DIVISION,
Washington, D. C.,
[TRANSCRIPT FROM RECORDS.]
<ttj^?p,pears from the records filed in this Office, that
C- ?3<*«*dfe. Go.J^r. , &... Reg't.
\v€slidmitted to &&<$$ft&&!3^1^:. Hospital,
for treatment for
fc^..r/0<<^fe?k*?fcsSJ<i^^
...(£.<wfa^_J?^^
fesnto«....^(S.«SS««^^
.<&fe
By order of the Surgeon General:
Vol.
.Breo>. Lieut. Col. and 4ss«. Suryeon, U. S. Army.(99) '
Ho.
(MoTB.—This certificate should hot be detached i'roBl the accompanying papers, If additional information is deaired relative tothe case, tills paper should accompany tile application therefor.)
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No.
NAME OF CLAIMANT,
NAME OF SOLDIER,
-.-Z^X^ -Z'—
(12172—50 M.) o 6—190