DECLARATION FOR ARREARS OF PENSIONS.
(Under sections 6 and 10, Act July 27, 1868.)
State of Tennessee | SCT.
County of Shelby
On this 4 day of September A. D. 1868, personally appeared before me, a clerk of Chancery Court within and for the county and State aforesaid, Mary Rollins, aged 30 years, a resident of Memphis, in the State of Tennessee, who, being duly sworn according to law, declares that she is the identical Mary Rollins to whom was granted Pension certificate No. 107851, payable at the agency at Nashville Tenn, and dated February 4, 1868; that under the limitations of the act of July 14 1862 was denied a Pension from the date of the (remarriage) death or discharge of Calvin Rollins late Corporal Co A 11 Regt U. S. C. Inft; and believing she is entitled to the same, under the 6 section of the act of July 27, 1868. She makes this declaration in order to secure the arrears accrued thereunder.
Her Post Office address is as follows: Memphis Tennissee
She further swears that she was not in the civil service of the U S Government at any time from March 3 1865 to Jun 6 1866
And she hereby constitutes and appoints JUSTUS I. McCARTY, of Washington, D. C., her Attorney, to present and prosecute this claim, and authorizes him to receive and receipt for any certificate, that may be issued for the same, and to do any other act or thing necessary or that she might do if personally present, with full power of subsittution and revocation, hereby countermanding all former authority that may have been given for the above specified purpose.
Signature of Claimant: Mary Rollins
<her X mark>
Also personally appeared Rachel Parks and Thomas Gatherns, residents of Memphis Tenn, persons whom I certify to be respectable and entitled to credit, and who, being by me duly sworn, say that they were present and saw Mary Rollins sign [left blank] (make her mark) to the foregoing declaration; and they further swear that they have every reason to believe, from the appearance of the applicant and their acquaintance with her that she is the identical person she represents herself to be; and they further state that they have no interest in the prosecution of this claim.
Signatures of Witnesses. | Rachel Parks
<Her X mark>
<His X mark>
Sworn to and subscribed before me this 4 day of September, A. D. 1868; and I hereby certify that I have no interest, direct or indirect, in the prosecution of this claim, and that I read over and explained the contents of the foregoing declaration and affidavit to claimant and witnesses before they signed their names thereto
Signature of Judge or other Officer. A. Alston, Clerk & Master
Chancery Court of Memphis