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AND I Amos Dole[handwritten] do solemnly swear, that I was a resident citizen of the United States on the eighteenth day of March one thousand eight hundred and eighteen, and that I have not since that time, by gift, sale, or in any manner whatever, disposed of my property, or any part thereof, with intent thereby so to diminish it as to bring myself within the provisions of an act of Congress, entitled "An act to provide for certain persons engaged in the land and naval service of the United States in the Revolutionary War," passed on the eighteenth day of March one thousand eight hundred and eighteen, and that I have not, nor has any person in trust for me, any property or se-curities, contracts or debts, due to me: nor have I any income, other than what is contained in the schedule hereto annexed, and by me subscribed.

[what follows is handwritten]
Real Estate. I have none
Personal Estate - 1 Horse &  Sleigh
1 Cow + 1 two year old Heifer
2 swine
1 old Plough + Harrow
6 Sheep

Owe one hundred + fifty Dollars + liable to be pursued for that payment. Am a Husbandman by occupation, very infirm + able to do but little Labor means of a Rupture and a lame knee.

Family; My Wife, Matilda Dole, aged 56 years (much out of health)
Daughter. Euphemia Dole, do. 18 do.(enjoys good health)
" Hannah Dole do. 14 do. (" bad health)
" Amelia [?] Dole do. 11. do (" good health)

Amos Dole [signature]