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[the following is a form with handwritten insertions]

DECLARATION,[header]
In order to be restored to the Pension List, under the Act of the 1st of March, eighteen hundred and twenty-three [preceding segment in italics]
STATE OF MAINE

Hancock, SS - At the Supreme Judicial Court[handwritten] begun and holden at Castine, within said for the County of Hancock, on the twentyfourth[handwritten] day of June[handwritten] and by adjournment thereof from day to day, on the [blank] day of [blank] in the year of our Lord one thousand eight hundred and twenty three[handwritten] before the Honorable Prentiss Miller[inserted] + Nathan Weston Jr. [handwritten] Judge of Said Court

ON this twentyfourth[handwritten] day of June[handwritten] in the year 182 3[handwritten] [1823]