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� [this document is a printed form with handwritten insertions noted]

State of Maine[header] KENNEBEC COUNTY, ss.

On this fiftth[handwritten] day of August[handwritten], 1820, personally appeared before Nathan Weston Junior a[handwritten] Judge of the Circuit[stricken] Supreme[inserted] Court of the State[inserted] Common Pleas for the Counties of Lincoln, Kennebec, and Somerset[stricken[ being a Court of Record for said Counties[stricken] State[inserted[ proceeding according to the course of the common law, having original jurisdiction, unlimited in amount, keeping a record of their proceedings, and having the power of fine and imprisonment, William Allen[handwritten] aged sixty three[handwritten] years resident in Etna[handwritten] in the County of Penobscot[handwritten] within Said State, who being first duly sworn according to law, doth, on his oath, declare that he served in the Revolutionary war as follows, viz. in the Company commanded by Captain White[handwritten] and Regiment commanded by Colonel Francis [?] Tupper[handwritten] of the line of the State of Massachusetts[handwritten] upon the Continental Establishment, to the period of [handwritten] three years and was in battle at the Taking of Burgoyne, at the Battle of Monmouth, and at the Storming of Stony Point [printed that his original declaration was made before Judge Kively[?][handwritten] on the ninth[handwritten] day of April[handwritten] 1818; that he is now on the Maine Roll, and that his pension certificate is numbered 9060[handwritten]. And I, the said William Allen[handwritten] do further 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 day, 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 provision of an Act of Congress, entitled, "An Act to provide for certain persons engaged on the land and naval services 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. Wm [William] Allen[signature]

The following is a Schedule of my whole Estate and income, necessary clothing and bedding excepted, viz:

[handwritten] Real Estate none [phrase underlined] four sheep of the value of four dollars one swine -- " -- four dollars old household stuff besides bedding seven dollars I have no debts due to be that can be collected and I owe as much one hundred dollars -- My occupation is that of a farmer, but from age and being subject to the Rheumatism, I am able[inserted] to do but very little labor. My family at home consists of three persons - myself, my daughter Susannah Brooks, who has been married & returned back to my family + her boy Eliphaniel [?] boy unable to take care of himself aged nine. Except the above and necessary clothing I have no estate or income whatever. Wm[William] Allen[signature