State of Missouri, County of Lincoln, SS:

            In the Pension Claim No. of Douglass W. Tice late of 6th Mo Cav vols 

Personally came before me, a Notary Public in and for the aforesaid County and State, Douglass W. Tice a citizen of Troy Mo whose post-office address is Troy Mo well-known to me to be reputable and entitled to credit, and who, being duly sworn, declares in relation to the aforesaid case as follows: 

            I am the claimant in the above claim, the reason the record shows I had Varicocele before my enlistment is in this way = About 1850 or 60 I rode a horse some 7 or 8 miles bare backed and in the ride I hurt one of my testicles and it swelled badly for several days but it got well and I never had any trouble from it; when I presented myself to Dr. Beshour — in Sept 1864 for certificate of disability in order to resign (he being A.A. Surgeon U.S.A. at Benton Barracks St. Louis Mo.) he examined me and pronounced it “Varicocele,” on left side, he asked me how long I had had varicocele I then told him about my ride bare-backed and he said may be that started it; and said as I was under marching orders to go south I had better make my case as strong as possible as it was difficult to get a resignation accepted while under marching orders and he made the statement of his own accord that I had had Varicocele for 2 or 3 years, but in fact I never had varicocele until the summer of 1864, after having been on a big scout; of some 8 or 10 days, had to leave my horse and take the ambulance from Patterson Mo to Pilot Knob Mo, where we were stationed

The above affidavit was prepared by the notary George W. Colliert in my presence at his office in Troy Mo. Dec. 4th 1896 from my oral declarations made to him that was not aided or assisted by any written or printed statement or recital prepared or dictated by any one. 

Douglas W. Tice

Sworn to and subscribed before me this 4th day of December A.D., 1896.

George W. Colliert

Notary Public

Term expires Dec. 17 1898