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� State of Maine

At a circuit court of Common Pleas begun and holden at Castine within and for the county of Hancock on the second Tuesday of July 1820

On this 11th day of July 1820 personally appeared in open court being a court of record by the laws of said State with powers of fine and imprisonment [inserted] Samuel Cousins aged 60 resident in Sedgewick in said County who first being duly sworn according to law on his oath declared that he served in the revolutionary war as follows, to wit three years from March 1777 in Captn Gilly Porters com in Col'l Eben Francis Reg't in the Mass'ts Line my Col'l was killed at Hubbardston Battle of which I made declaration before the Hon'ble Wm Crosby one of the Judges of said court on the 10th day of April 1818 and from which I have received a pension certificate No 15543 and

[pre-printed form with handwritten deletions] I Samuel Cousins [stricken] aforesaid [stricken] 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.

Samuel Cousins[signature] [stricken] [stricken] [stricken] Sworn to and declared on the 14th day of July 1820 Before the court att Mason Shaw Clerk