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And in pursuance of the act of the first of May 1820, I do solemnly swear that I was a resident Citizen of the United States on the 18th day March 1818 and that I have not since that time by gift [illegible] or in any manner disposed of my property or any part thereof, with intent thereby, so to diminish it, as to bring myself within the processions 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 18th day of March 1818: and that I have not nor has any person in trust for me any property or securities or debts due to me; nor have I any income other that what is mentioned in the Schedule hereafter mentioned and by me subscribed; That my occupation is a common laborer and my ability to pursue the same by reason of Age, infirmity and blindness, together with the number and other particulars of my family are in fact and in truth as is herein particularly described by me. I have a Wife aged forty seven years (but sickly). I have three Children, Maria, thirteen years old. Thomas twenty years old and Autumn twenty two years old, but all of my Children have left me and are unable to give me any assistance. I further swear that I have no real nor personal property, except some necessary bedding and poor apparel [illegible series of words added at this point] and that I am in  such indigent circumstances as to be unable to support myself without the assistance of my Country except by private or public Charity.
[Illegible signature]

Schedule of personal estate (necessary clothing and bedding excepted) belonging to me.
One Case value  ----------- $15.00
1 pig  -  do.   ---------------     3.00
other small articles - do. ---   5.00
                                            _______
                                           $23.00
[illegible signature]
Total value $23  Sworn to this 21st day of June 1825
                          Before the court- [illegible] Poor, Clerk