Declaration For Original Invalid Pension

To be executed before a court of record or dome officer thereof having custody of its seal.

State of Ohio } ss
County of Highland

            On this 24^th day of May, A. D. one thousand eight hundred eighty –––– personally appeared before me a Judge of the Probate Court, a court record within and for the county and State aforesaid Wilson M. Evans, aged 47 years, a resident of near Samantha, county of Highland, State of Ohio, who being duly sworn according to law, declares that he is the identical Wilson M. Evans who was ENROLLED on the 15 day of Sept, 1864, in company “D” of the 16^th regiment of Tenn- U. S. Col. Commanded by Capt. Will. Blunt, and was honorably DISCHARGED at Chattanooga Tenn on the 15^th day of Sept, 1865; that his personal description is as follows: Age, ___ years; height, ___ feet ___ inches; complexion, ____; hair, _____; eyes, _____. That while a member of the organization aforesaid, in the service and in the line of his duty at Chattanooga, in the State of Tenn. on or about the ____ day of Jan, 1865, he contracted deafness of both ears––– caused by laying out on wet ground catching cold and it settled in his head—! his head [gathered?] [and] his ears has been running ever since––– his head pains him–––and he is so greatly annoyed and it is source of great inconveniences and pain.

That he was treated in hospitals as follows: none–––

That he has not been employed in the military or naval service otherwise than as stated above.

That since leaving the service this applicant has resided in the County of Highland in the State of Ohio, and his occupation has been that of a Farmer. That prior to his entry into the service above named he was a man of good, sound, physical health, being when enrolled a Farmer. That he is now in part disabled from obtaining his subsistence by manual labor by reason of his injuries, above described, received of the service of the United States; and he therefore makes this declaration for the purpose of being placed on the invalid pension roll of the United States.

            He hereby appoints, with full power of substitution and revocation, A. D. Wiggins of Hillsboro, State of Ohio, his true and lawful attorney to prosecute his claim. That he has never received nor applied for a pension. That his Post Office Address is Samantha, county of Highland, State of Ohio.                                  

Claimant’s signature: [his X mark] Wilson M.  Evans

Attest: H. T. Greuber
Daniel Thax