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[handwritten]
I Eleazer Dickey on oath say and dec-lare, that I have no real nor personal Estate nor any income whatever, my necessary bedding and wearing apparel excepted, except one hired cow.

I am a laborer, but by reason of age and infirmity, I am not able to labor. My wife is aged and infirm. I have five children under age.
Hallet 17 years old
Patty 15  Do
Hambleton 13 Do
Jane 11 Do
Alexander 9 Do

I am unable to support myself and family without my pension.

Eleazer Dickey[signature]