APPLICATION FOR ARREARS OF PENSION.
To the Commissioner of Pensions:
STATE OF NORTH CAROLINA, | SS.
Signed in my presence by Susan Ann Dove who is known to me to be the person she describes herself to be, and at the same time she exhibited to me her pension certificate, which is numbered 147996.
M. S. Palmer
[on back of document]
Sol. died in service - penr fr April, 18, 1865, date of Sol death
[stamped] DEPARTMENT OF THE INTERIOR. PENSION OFFICE. SEP 22 1879