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� [the following is a pre printed form with handwritten notes and schedules, handwritten will be noted]

STATE OF MAINE[header]

COUNTY OF PENOBSCOT, ss At a[handwritten] Circuity Court of Common Pleas begun and holden at Bangor within and for said County on the fourth Tuesday of June A.D.1820[handwritten]

On this twentyseventh[handwritten] day of June[handwritten] in the year of our Lord eighteen hundred and twenty, personally appeared in open Court, being a court of record within and for said County and State of Maine, having the right of fine and imprisonment[handwritten insertion] established by a law of the Commonwealth of Massachusetts, made and passed on the eleventh[stricken] twentyfirst[handwritten] day of June A.D. 1811, and recognized by the Constitution of the State of the Maine, Samuel Bailey[handwritten] aged fifty eight[handwritten and stricken] 64 years, resident in Sundahayes[?] Plantation, in said County of Penobscot, who being first duly sworn according to law, doth, on his oath, declare that he served in the Revolutionary war as follows:

[handwritten] viz. in the year 1777 I enlisted for three years and served during that time as a musician under Captain Benjamin Buxton and under Captain Joshua Trafton[?] in the Regiment commanded by Colonel Henry Thornburn[?] and Colonel Henry Jackson and at the exhaustion of said time was honorably discharged. I served three other years in the Revolutionary War and not on the Continental Establishment - all which will appear by my original declaration made on the twentysecond day of April A.D. 1818 on which declaration my certificate of pension numbered 9.166[?] was granted.

I served in Bunker Hill [underlined] battle - also at Rhode Island at 1778 - also in a private expedition lead by Lord Stirling at Staten Island in January 1780.

Schedule of the family residing with me Samuel Bailey who is by occupation a harrow[?]wright, which I am made to presume by means of [?] ability and wholesome constitution - My Wife - aged sixty three years, who is very infirm My Son Daniel - aged nineteen years - I have for many years subsisted on the charity of friends until my pension has relieved [?] from that burden

Samuel Bailey[signature]

[return to pre printed form] AND I Samuel Bailey[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 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.

[handwritten] Samuel Bailey[signature] [?][stricken] Schedule of Property belonging to me that [?] necessary begging and clothing excepted - Viz - Real estate - None Personal estate - one cow + one small pig I have no debts of any kind due to me. Samuel Bailey[signature]

Sworn to and declared on the twenty seventh day of June A.D. 1820 before the Court. Att. Thos Cobb Clerk

[printed and stricken] I, THOMAS COBB, Clerk of the Circuit Court of Common Pleas, for the Third Eastern Circuit, in the County of Penobscot and State of Maine, do hereby certify that the foregoing, oath[handwritten] and the schedule thereto annexed, are truly copied from the records of said Court: and I do further certify that it is the opinion of the said Court, that the total amount in value of the property exhibited in the aforesaid schedule, is twenty[handwritten] dollars and [blank] cents. IN TESTIMONY WHEREOF, I have hereunto set my hand, and affixed the seal of the said Court, on this twenty seventh[handwritten] day of June[handwritten] A.D.1820 Thos. Cobb [signature] Clerk of the said Court for the County of Penobscot.

[handwritten] Penobscot fr. C.C.C. Pleas at Bangor, June Term A.D. 1820. And now it is the opinion of the Court that the total amount in value of the property exhibited in the aforesaid Schedule is twenty dollars. Att. Thos Cobb Clerk