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[the following is a pre-printed form with handwritten insertions]

STATE OF MAINE

Hancock[handwritten] ss
At a Circuit Court of Common Pleas for the Third[handwritten] Eastern Circuit, begun and holden at Castine[handwritten] within and for the County of Hancock[handwritten] on the second Tuesday of July [handwritten] being the eleventh[handwritten] day of July[handwritten] and by adjournment [blank] from day to day, on the fourteenth[handwritten] day of said month[handwritten] in the year of our Lord one thousand eight hundred and twenty before the Honorable William Crosby + James Campbell[handwritten] Judge s [rendered Judges handwritten]  of said Court

On this fourteenth[handwritten] day of July[handwritten] in the year 1820, personally appeared 
in open Court[handwritten]
the same proceeding according to the course of the common law, having jurisdiction unlimited in amount, keeping a record of their proceedings, and having "the power of fine and imprisonment," and being a Court of Record for said Circuit,Charles Branscom [handwritten] aged seventy one[handwritten] years, resident in Mount Desert[handwritten] in said Circuit who being first duly sworn according to law, doth on his oath declare that he served in the Revolutionary War as follows, viz as a Private[handwritten] in the company commanded by Capt. Mavory[?] + Livermore[handwritten] in the Regiment commanded by Colonel Francis + Tupper [handwritten] in the line of the State of Massachusetts[handwritten] on the Continental Establishment as is more particularly mentioned and declared in his original declaration, made on the eighteenth[handwritten] day of April[handwritten] A.D. 1818 and on which said declaration his Certificate of Pension numbered 9.159[handwritten] was granted. And I do solemnly swear that I was a resident citizen of the United States on the 18th day of March 1818; and that I have not since that time by gift, sale, 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 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 18th day of March, 1818; and that I have not, nor has any person in trust for me, any property or securities, 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; that my occupation and ability to pursue the same, together with the number and other particulars of my family, are in fact and in truth as is particularly described on the back hereof, also subscribed by me.
his[handwritten]
Charles +[mark] Branscom[handwritten]
mark[handwritten]

Sworn to and declared on the 14th[handwritten] day of July[handwritten] A.D. 1820 }
Before William Crosby & James Campbell Sr.[handwritten] }
One of the[stricken]
Judges of the said Court
attest Mason Shaw Clerk