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� [the following is a pre-printed form with hand written insertions, deletions, testimony and schedules]

STATE OF MAINE

COUNTY OF PENOBSCOT, ss. At [handwritten] Circuit Court of Common Pleas begun and holden in Bangor within and before said county on the fourth Tuesday of June A.D. 1820. [handwritten]

On this 27 [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 the State of Maine, 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 Maine, and having power of fine and imprisonment [handwritten]

Ezekiel Chase [handwritten] aged fifty nine [handwritten] years, resident in Sebec [handwritten] in said county of Penobscot, who first being duly sworn according to law, doth, on his oath declare that he served in the Revolutionary War as follows:

[handwritten]

in the company commanded by Captain Benjamin Burton in Col'l Henry Sherbournes Regt in the Rhode Island Line & in the company commanded by Captain -- Hastings in the Regiment commanded by Col'l Henry Jackson in the Massachusetts Line - and in the company of Light Infantry commanded by Captain William Scott in the Regiment commanded by Colonel Henry Ogden -- All which will more fully appear by my original declaration made on the eighth day of January 1819 on which my certificate of pension numbered 11.379 was granted.

And I Ezekiel Chase [handwritten] 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.

Ezekiel Chase

[handwritten] Schedule of Property belonging to me the [?] necessary bedding + clothing excepted

Real Estate - one hundred acres of land in Sebec together with house + barn one right in equity to redeem 100 acres of land in Sebec now $20

Personal estate 5 cows, 12 sheep, 3 swines Debts due to me - None Estate true + justly [?] $300 Ezekiel Chase

Schedule of family residing with me the [?] who am by occupation an husbandman but am unable to humor it by reason of infirm health Viz My wife aged 57 years Feeble Daughter Abigail " 19 " ----- Son Caleb " 7" ----- Son Charles " 14 " ---- Son Owen " 9 " ----- Ezekiel Chase

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

Penobscot C.C.C. Pleas at Bangor June Term 1820 And now after mature consideration it is the opinion of the Court that the total amount in value of the property exhibited in the aforesaid Schedule is four hundred seventeen dollars Attest Thos Cobb Clerk

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